Ken Grauer, MD

MARCH 23, 2023

The 12-lead ECG and long lead II rhythm strip shown in Figure-1 — was obtained from a previously healthy, elderly woman who collapsed in the hospital parking lot. She underwent cardiopulmonary resuscitation for VT/VFib — with ROSC ( R eturn O f S pontaneous C irculation ) following defibrillation and treatment with Epinephrine and Amiodarone. A series of cardiac arrhythmias were seen during the course of her resuscitation — including the interesting arrhythmia shown in the long lead II of Figure

EKG/ECG 195

EKG/ECG Resuscitation Hospitals 195

EMCrit

MARCH 21, 2023

Steroid is worthless for pneumonia! Wait, a new study shows it's beneficial! Hang on, a fresh meta-analysis shows that steroid it's useless! And wait, here's a fresh NEJM study showing mortality benefit!! This feels like a roller coaster. What's going on here? Several factors may explain this: Steroid is beneficial, but only in a subset […] EMCrit Project by Josh Farkas.

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Mount Sinai EM

MARCH 20, 2023

Sickle cell disease affects ~ 100,000 people in the US. Though pain is the most common ED presentation for patients with SCD, we should always consider life-threatening emergencies in this devastating and complicated disease. Acute Chest Syndrome ACS is the leading cause of morbidity and mortality in patients with SCD. It’s caused by sickling in the pulmonary vasculature, leading to a cycle of hypoxia, vaso-occlusion, and consequently more hypoxia.

Stroke 130

Stroke Pediatrics 130

NRC Health

MARCH 22, 2023

NRC Health is named to Becker’s 'top places to work in healthcare' list for 2023. The post NRC Health named to Becker’s ‘top places to work in healthcare’ list appeared first on NRC Health.

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Ken Grauer, MD

MARCH 18, 2023

The ECG in Figure-1 was obtained from a man in his mid-60s — who presented with new chest pain. Should the cath lab be activated? Figure-1: T he initial ECG in today’s case. Should the cath lab be activated? MY Thoughts on the Initial ECG: The rhythm in ECG #1 — is sinus at ~70/minute. All intervals ( PR, QRS, QTc ) are normal. There is no chamber enlargement.

EKG/ECG 195

EKG/ECG Wellness 195

Mind The Bleep

MARCH 22, 2023

Introduction Clinical Definition An open fracture is when the broken bone breaks through the skin or any other body cavity that is open to the outside, including those through the rectum or vagina. Classification Gustilo and Anderson Classification 1,2 Type Wound Size Contamination Fracture Arterial injury requiring repair Soft Tissue Coverage 1 < 1cm Minimal Minimal None Adequate – local 2 1-10cm Moderate Moderate None Adequate – local 3A >10cm Extensive Severe None Adequate

Fractures 59

Fractures Documentation/Coding Operations Hospitals 59

Mount Sinai EM

MARCH 20, 2023

Trauma is the leading cause of non-obstetric death in pregnant women. MVAs and intimate partner violence account for most cases. Let’s first discuss the physiological changes to consider when managing a pregnant patient in a trauma. AIRWAY : Progesterone: floppier airway with more edema Predict a more difficult tube Decreased esophageal tone and -> higher risk for aspiration Decompress early with NG or OG tube BREATHING : Increase in respiratory drive -> hyperventilation -> chronic r

Documentation/Coding 100

Documentation/Coding Resuscitation 100

Canadian EM

MARCH 24, 2023

We’re back again with another edition of the CJEM: Visual Abstract series. In this collaboration with the Canadian Journal of Emergency Medicine, we select one abstract monthly to highlight with a visual abstract. For March 2023, we selected: “The efficacy of prehospital IV fluid management in severely injured trauma patients: a systematic review and meta-analysis”.​1​ We hope you enjoy!

Shock 52

Shock 52

Trigger Lab

MARCH 23, 2023

I deal with a complex and recent subject that is of great importance in monitoring patients afflicted with ARDS: the Patient Self-Inflicted Lung Injury (P-SILI). The objectives of this piece are divided into two parts: DEFINING P-SILI Over the past 20 years, several important aspects concerning ARDS patients have been emphasized.

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RebelEM

MARCH 23, 2023

Background information : Alcohol has potentiating effects on the inhibitory GABA neurotransmission system and inhibitory effects on the excitatory glutamate neurotransmission system. Chronic alcohol use causes changes to preserve homeostasis, and when the stimulus is removed, alcohol withdrawal results due to decreased inhibition via the GABA system and increased excitation via the glutamate system.

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Emergency Department Outcomes Burns Hospitals 52

The Bottom Line

MARCH 22, 2023

In patients with severe community acquired pneumonia (CAP) does the use of hydrocortisone compared to a placebo reduce 28-day mortality?

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NRC Health

MARCH 21, 2023

NRC Health's 29th annual conference, Human Understanding Beyond | HUB23, is set to take place August 9–11, 2023, in Boston. The post Human Understanding Beyond | HUB23 preview: Engaging presentations planned for Consumer Track appeared first on NRC Health.

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Dr. Smith's ECG Blog

MARCH 20, 2023

Submitted by Dr. Caio Aguiar from Brazil, written by Pendell Meyers It is immensely rewarding to receive these emails, like I received from Dr. Aguiar last week: "Last year I had a couple of lessons with you while on my internship. I finished my residency of Emergency Medicine and I’m working at a great Emergency Department here in Brazil. Since then, I started looking for OMI EKG findings and not just STEMI.

EKG/ECG 52

EKG/ECG Emergency Department Wellness 52

RebelEM

MARCH 22, 2023

Take Home Points AVNRT is a common tachydysrhythmia that results from a reentrant loop within the AV node. Unstable patients with AVNRT should be considered for immediate synchronized electrical cardioversion. Stable patients with AVNRT can have a trial of vagal maneuvers followed by chemical cardioversion with adenosine or verapamil and synchronized electrical cardioversion if that fails.

EKG/ECG 52

EKG/ECG EMS Pediatrics Stroke 52

Cook County EM Blog

MARCH 20, 2023

Image 1: X-ray AP and and lateral thumb views A 42-year-old right hand dominant male with no known past medical history presents with pain in his right thumb. He works as a painter and was using an industrial paint sprayer when he injected a water-based paint into his right distal thumb pad. He states he had significant pain initially, but it quickly settled to a dull throbbing.

Documentation/Coding 52

Documentation/Coding Fractures Operations Research 52

American Medical Compliance

MARCH 20, 2023

American Medical Compliance offers Enterprise Training Modules to businesses. These modules allow businesses to provide world-class, industry-specific compliance training to employees that fully integrate with platforms used by employers. What are Enterprise Training Modules? Enterprise Training Modules are customized compliance courses delivered to entire workplaces.

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Stop and Think

MARCH 19, 2023

Soft thinking is a like a contagious disease. If you don’t treat it early, it will spread to the masses and become endemic. Almost every day, I ask myself if I am guilty of soft thinking. Have I underestimated complexity? Have I accepted weak evidence? Here is the problem: thinking about the quality of your thinking produces tension. One force is that getting by in medicine requires pragmatism.

Outcomes 52

Outcomes Stroke Hospitals 52

Dr. Smith's ECG Blog

MARCH 19, 2023

This ECG was texted to me in real time, but I did not notice the message until about an hour after it came. "50 + yo. Concerning history, known CAD" Recorded 2 hours after pain onset: What do you think? This was my response: "This looks like a worrisome EKG. It looks like an Occlusion MI (OMI), but I am not 100% certain. But by now you must have a repeat ECG.

EKG/ECG 52

EKG/ECG Documentation/Coding Wellness 52

Board Bombs

MARCH 19, 2023

Do you even life bro? Clearly not. Iron supplements are all the rage (jk, they are awful to take). Unfortunately they are often accidentally ingested by children as they are brightly colored and sugar-coated. Let’s talk iron toxicity, its presentation, diagnosis, and management. Want to experience the greatest in board studying? Check out our interactive question bank podcast- the FIRST of its kind here: emrapidbombs.supercast.com.

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EMergucate

MARCH 18, 2023

The following chest x-ray is from a 42-year-old with asthma exacerbation. What can be noticed?

EMS 52

EMS 52

The Skeptics' Guide to EM

MARCH 18, 2023

Date: February 27, 2023 Reference: Walsh PS, Schnadower D, Zhang Y, Ramgopal S, Shah SS, Wilson PM. Association of early oseltamivir with improved outcomes in hospitalized children with influenza, 2007-2020. JAMA Pediatr. 2022. Guest Skeptic: Dr. Marisu Rueda-Altez is a pediatric infectious disease fellow at Children’s National Hospital in Washington, DC.

Pediatrics 40

Pediatrics Infectious Diseases Administration Outcomes 40

University of Maryland Department of Emergency Med

MARCH 24, 2023

Patellofemoral anatomy and disease (part 1) During normal knee flexion, the patella slides within the trochlear grove. Both (patella and t.

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JournalFeed

MARCH 18, 2023

The JournalFeed podcast for the week of March 13-17th, 2023. These are summaries from just 2 of the 5 article we cover every week! For access to more, please visit JournalFeed.org for details about becoming a member. CPR Fatigue Spoon Feed In this study of firefighters performing CPR with feedback devices, researchers found that compression depth decreased over the course of a two-minute chest compression cycle while compression rate stayed within goal.

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CPR Research 40

EMergucate

MARCH 20, 2023

21-year-old man brought for ED for impaired mental state, he was extremely agitated and needed 6 staff members to restrain … Continue reading →

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Dr. Smith's ECG Blog

MARCH 24, 2023

Written by Jesse McLaren, with comments from Smith An 85 year old with a history of CAD presented with 3 hours of chest pain that feels like heartburn but that radiates to the left arm. Below is the ECG. What do you think? There’s sinus bradycardia, first degree AV block, normal axis, delayed R wave progression, and normal voltages. There’s minimal concave ST elevation in III which does not meet STEMI criteria, so this ECG is "STEMI negative".

EKG/ECG 52

EKG/ECG Research Emergency Department Outcomes 52

University of Maryland Department of Emergency Med

MARCH 20, 2023

Things to Consider for Persistent or Worsening Septic Shock Septic shock is one of the most common critical illnesses in emergency.

Shock 40

Shock 40

University of Maryland Department of Emergency Med

MARCH 18, 2023

Predicting the need for a mass hemorrhage protocol (MHP) activation is important both for individual patient outcome as well as for prope.

Outcomes 40

Outcomes Wellness 40