Ken Grauer, MD

SEPTEMBER 13, 2024

I was sent the ECG shown in Figure-1 — being told only that providers on the case suspected AFib ( A trial Fib rillation ) with RBBB ( R ight B undle B ranch B lock ) aberrancy. QUESTIONS: Is the wide tachycardia that is seen best in the chest leads, too irregular to be VT ( V entricular T achycardia )? — How certain are YOU of your answer? Figure-1: The initial ECG in today's case. ( To improve visualization — I've digitized the original ECG using PMcardio ). == PEARL # 1: Before reviewing my a

EKG/ECG 248

EKG/ECG Wellness 248

The Trauma Pro

SEPTEMBER 13, 2024

There are basically four indications, two absolute and two relative : Absolute #1 : entrapped extremity with a lengthy extrication and a physiologically impaired patient who does not respond to fluids. In this case, there is occult blood loss in other areas that is killing your patient, and they need to get out quickly for definitive management. Absolute #2 : entrapped extremity with a lengthy extrication and an unstable physical environment.

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Dr. Smith's ECG Blog

SEPTEMBER 12, 2024

Written by Pendell Meyers A man in his 40s called EMS for acute chest pain that awoke him from sleep, along with nausea and shortness of breath. His history included known heart failure with prior EF 18%, insulin dependent diabetes, and polysubstance abuse. Vitals were within normal limits except for tachypnea. Here are his EMS ECGs along with the Queen of Hearts interpretations below each one: EMS1 0650 EMS2 0707 Click here to sign up for Queen of Hearts Access The ECGs show RBBB and LAFB, with

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EKG/ECG EMS Documentation/Coding Shock 123

Science Based Medicine

SEPTEMBER 8, 2024

Bhattacharya, Atlas, and Makary are also set to speak at Stanford next month The post Hopkins Business School to Platform COVID-19 Contrarians at Health Policy Symposium first appeared on Science-Based Medicine.

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Sensible Medicine

SEPTEMBER 8, 2024

I only read two articles last week (Labor Day, a wedding, having to debate, and then write and article with Vinay…). At first glance they seem very different, but they actually have quite a bit in common. Both were “suggested to me” -- one by a Sensible Medicine reader and one by a twitter-colleague. Both relate to topics I have expressed pretty strong opinions about, opinions that I fully recognize might be wrong.

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Research Hospitals 113

The Trauma Pro

SEPTEMBER 10, 2024

Field amputation is not thought of very often, and for good reason. It is unpleasant, uncommon, and not very safe for trauma professionals due to the austere environment. I will dedicate the next several posts to the topic, starting with some of the facts. First, let’s start with definitions. Two distinct procedures are discussed here. The first and most commonly described is field amputation.

EMS 201

EMS Documentation/Coding 201

Dr. Smith's ECG Blog

SEPTEMBER 7, 2024

A 70-something y.o. male presents to triage with shortness of breath. He reports significant chest pain at the base of his scapula on the right side along with new shortness of breath. ECG 1 at time zero EARLY REPOLARIZATION ABNORMAL ECG ED final official overread: "early repol vs hyperacute T, minimal changes from previous (previous shown below)" What do YOU think?

EKG/ECG 118

EKG/ECG Research Wellness 118

Sensible Medicine

SEPTEMBER 9, 2024

In his post yesterday, Adam discussed the STRONG-HF trial. I will expand on it because it is a great example of a positive trial that does not add knowledge to the treatment of patients with heart failure. The larger question is: what are trials for? When I think about science classes in high school, I remember experiments as a way to explain nature.

Hospitals 106

Hospitals Outcomes Research 106

Emergency Medicine Cases

SEPTEMBER 10, 2024

On this month's EM Quick Hits podcast: Ian Chernoff on the often elusive diagnosis of traumatic coronary artery dissection, Anand Swaminathan on proper use of insulin in DKA and in hyperkalemia, Brit Long and Hans Rosenberg on mesenteric ischemia pearls and pitfalls in diagnosis and management, Dave Jerome on recognition and management exercise-associated hyponatremia and heat illness and Jesse McLaren on the Queen of Hearts AI model in helping identify occlusion MI on ECG.

EMS 100

EMS EKG/ECG 100

Dr. Smith's ECG Blog

SEPTEMBER 11, 2024

A former resident texted me this case: "Hey Dr. Smith. Hope you’re doing well! How excited would you have been about this case?" Here is the case: Report from EMS was witnessed syncope, his son did CPR, but the patient had pulses when EMS arrived. When the patient arrived in the ED, he was still hypotensive in 70s, slowly improving with EMS fluids. No Chest Pain, but somnolent.

EMS 113

EMS CPR EKG/ECG Wellness 113

American Medical Compliance

SEPTEMBER 9, 2024

In assisted living, one of the most critical aspects of resident care is the prevention and management of skin issues. For instance, one of the most common risk factors associated with the development of pressure ulcers is being 70 years of age or older. Skin health is not only a matter of comfort and well-being but also a key indicator of a resident’s overall health status.

Teamwork 95

Teamwork Best Practices Outcomes Wellness 95

Taming the SRU

SEPTEMBER 12, 2024

Weakness is a common, though sometimes vague, presenting symptom in the ED. Neuromuscular (NM) weakness can have various causes, ranging from common and relatively easy to diagnose conditions (such as strokes and trauma) to less common and more difficult to diagnose ones (such as vascular pathologies, infections, autoimmune diseases, and neoplasms).

Stroke 88

Stroke 88

Core Medical Group

SEPTEMBER 12, 2024

At CoreMedical Group , our QA team is the backbone of your job placement journey. From finding travel nursing and therapy opportunities to getting you started in new locations, our QA experts, alongside your recruiter, ensure everything is top-notch. Whether it’s your first or fifteenth assignment , we’ve got your back with personalized service, helping with applications, licensing, housing, and even some local tips for your new destination.

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EB Medicine

SEPTEMBER 13, 2024

In this episode, Sam Ashoo, MD and T.R. Eckler, MD discuss the September 2024 Emergency Medicine Practice article, Elder Abuse and Neglect: Making the Diagnosis and Devising a Treatment Plan in the Emergency Department Introduction and Announcements Elder Abuse and Neglect: An Overview Risk Factors and Reporting Pre-Hospital and Emergency Department Considerations Screening Tools and Physical Examination Documentation and Disposition Cultural Considerations and Future Directions Conclusion an

Elder Abuse 85

Elder Abuse Emergency Department Documentation/Coding Hospitals 85

EM Literature of Note

SEPTEMBER 13, 2024

Every year, we have our peak of respiratory viruses – traditionally influenza, respiratory syncytial virus, and their accompanying lessor demons. These are each awful, of course, in their own way from a patient- and parent-oriented standpoint, but they’re also quite awful at the population level, overburdening limited pediatric and emergency department resources.

Emergency Department 85

Emergency Department Pediatrics Administration Wellness 85

First 10 EM

SEPTEMBER 9, 2024

Welcome back to another research roundup. This edition doesn’t have any immediate practice changers, but I think there are some very important topics. Enjoy. The BroomeDocs podcast: [link] The BroomeDocs podcast on YouTube: (I am on vacation, so this will probably be inserted later.) In a surprise to no one who reads First10EM, clinical judgment […] The post The September 2024 Research Roundup appeared first on First10EM.

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Research Sepsis EMS 85

Science Based Medicine

SEPTEMBER 11, 2024

It seems there is an endless stream of artificial intelligence (AI) news coming out, and this includes the field of medicine. There also continues to be a debate about the true impact of AI – how much is hype, and how much is a genuine advance that can transform our technology? As with many technological advances, it’s both. New tech, perhaps especially […] The post Update on AI in the Clinic first appeared on Science-Based Medicine.

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EMDocs

SEPTEMBER 8, 2024

Welcome to the emDOCs Videocast – please subscribe to our YouTube channel. These videos will cover post summaries, take homes on clinical condition, and EBM/guideline literature updates. Today we focus on IV blood pressure medications in patients with neurovascular emergencies. EBM Update: IV BP Meds in NV Emergencies Background: There is no one agent that is recommended over others for reducing elevated BP in those with neurovascular emergencies.

Stroke 81

Stroke Outcomes Hospitals 81

Sensible Medicine

SEPTEMBER 10, 2024

I am a proud American and an avowed capitalist. I am sure that Adam Smith’s “invisible hand of the free market” maximizes social benefits. Capitalism has its flaws – the concentration of wealth and environmental degradation among others -- but no other system is as good at organizing societies and improving standards of living.

Wellness 73

Wellness 73

Dr. Smith's ECG Blog

SEPTEMBER 9, 2024

Written by Willy Frick A 40 year old woman was at home cooking when she developed chest pain. She took an oxycodone and called EMS. Her presenting ECG is shown below: ECG 1 What do you think? I sent this to Drs. Meyers and Smith and the response was: "I’m quite confident that this is OMI." Here is the Queen's verdict with explainability: She sees OMI with low confidence.

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EKG/ECG Operations Wellness Ultrasounds 70

Science Based Medicine

SEPTEMBER 13, 2024

As RSV approaches, some "real world" data out of France provides even more support for the RSV antibody shot for babies. The post More Evidence Supports Infant RSV Shot Safety and Effectiveness first appeared on Science-Based Medicine.

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EMDocs

SEPTEMBER 7, 2024

Author: Iosif Davidov, MD (EM/IM/CC/Ethics Fellow at North Shore/LIJ Northwell Health System) // Reviewed by: Sophia Görgens, MD (EM Physician, BIDMC, MA); Cassandra Mackey, MD (Assistant Professor of Emergency Medicine, UMass Chan Medical School); Alex Koyfman, MD (@EMHighAK) Welcome to EM@3AM, an emDOCs series designed to foster your working knowledge by providing an expedited review of clinical basics.

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EMS Fluid Resuscitation Resuscitation Radiology 75

Sensible Medicine

SEPTEMBER 12, 2024

Sensible Medicine is excited to publish this rejected letter to the editor of the journal JACC-HF. Our excitement comes from a) the specific lessons about the design of clinical trials, and b) we love being a place where strongly argued but contrary viewpoints can be read. The specifics concern Chagas cardiomyopathy, which is caused by Trypanosoma cruzi infection.

Academics 68

Academics Outcomes Hospitals Wellness 68

ALiEM

SEPTEMBER 13, 2024

A 32-year-old male with no significant past medical history presented to the emergency department (ED) from an outside hospital for further management of right eye pain and vision loss sustained after he was struck by a metal wire while at work. The patient presented to an outside “eye doctor” and was told to go to the nearest hospital for evaluation.

Emergency Department 64

Emergency Department Academics Fractures Hospitals 64

Science Based Medicine

SEPTEMBER 12, 2024

New research suggests that cannabis use may be harmful and could be causing cardiovascular disease. The post Cannabis use and cardiovascular disease first appeared on Science-Based Medicine.

Research 71

Research 71

RebelEM

SEPTEMBER 9, 2024

A newborn boy presents to the emergency department shortly after a home delivery. The mother had routine prenatal care and reports that he was due in 2 days. The patient appears term and vigorous but is in respiratory distress and gasping for air. His heart rate is 80 bpm. What percent of oxygen should you initially use while providing positive pressure ventilation to this patient?

Resuscitation 58

Resuscitation Emergency Department Pediatrics EMS 58

Sensible Medicine

SEPTEMBER 13, 2024

PJ is a 53-year-old woman referred for a consultative visit. For the last 12-18 months she has been suffering from fatigue, headache, joint pain, and rashes. She has been seeing a primary care internist and has had consultations with a neurologist, a dermatologist, and a rheumatologist. She presents with a folder of records and codes for outside EMRs.

Psychiatric 60

Psychiatric Documentation/Coding Radiology Radiology 60

ALiEM

SEPTEMBER 9, 2024

A 61-year-old female with a past medical history of hypertension, hyperlipidemia, type 2 diabetes, and normal pressure hydrocephalus s/p VP shunt (last revision nine months ago) presented to the Emergency Department (ED) for evaluation after noticing a “string” coming out of her anus today. Associated symptoms included nausea and a mild headache for one day, and one episode of vomiting prior to arrival.

Sepsis 60

Sepsis Academics Operations Emergency Department 60

EMergucate

SEPTEMBER 13, 2024

The chest x-ray shows medial displacement of the gastric bubble by an enlarged spleen.

EMS 52

EMS 52

Emergency Live

SEPTEMBER 13, 2024

Substances that promote tissue growth and repair are produced during sleep In recent years, scientific research has increasingly highlighted the importance of night rest for our health, especially heart. Why is sleep so important for the heart? During sleep, our body is engaged in a number of fundamental repair processes. The heart slows down, blood […] The post Why is sleeping more on the weekend good for the heart?

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Research 52

Life in the Fast Lane

SEPTEMBER 12, 2024

Mark Corden Funtabulously Frivolous Friday Five 360 Funtabulously Frivolous Friday Five 360 - Just when you thought your brain could unwind, enter the medical trivia of FFFF.

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RCEM Learning

SEPTEMBER 12, 2024

The NIHR supported Emergency Care Incubator invites healthcare professionals working in urgent and emergency care to join us for our 3rd interactive symposium

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Research 52

EMergucate

SEPTEMBER 13, 2024

The pelvic x-ray shows a fracture of the right ilium.

Fractures 52

Fractures EKG/ECG EMS 52

Emergency Live

SEPTEMBER 13, 2024

Recent research suggests that intermittent fasting may hide unexpected risks Intermittent fasting, a diet that involves periods of abstinence from food alternating with food windows, has become increasingly popular in recent years, promising a range of health benefits, from weight loss to improved metabolic health. However, recent research from the Massachusetts Institute of Technology (MIT) […] The post Intermittent fasting: new research raises concern appeared first on Emergency Live.

Research 52

Research 52

Don't Forget the Bubbles

SEPTEMBER 11, 2024

This post accompanies Andy Tagg’s talk for Grand Rounds for RU OK Day I have a confession to make to you all. And I know this is a safe space, so here it goes… I am burnt out. I have been a doctor for half of my life, and my journey to burnout has been a 25-year slow burn that began the day I graduated. I had always wanted to be a doctor, and only now do I recognise my parents’ sacrifices to get me to where I am today.

Burns 52

Burns Hospitals Emergency Department Wellness 52

PEMBlog

SEPTEMBER 9, 2024

Dewdrops on a rose petal describes the classic appearance of the lesions in varicella infections. Chicken pox is preventable by vaccines you know… Lyrics [Chorus] Dewdrops on a rose petal Vaccines test your mettle it’s chicken pox you silly fox! [Verse] prodrome fever, body hurts then the rash arrives in spurts Varicella’s itchy lesions most on trunk for some reason scabbing over, different stages once all crusted, not contagious [Chorus] Dewdrops on a rose petal Vaccines test

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Infectious Diseases 52

EMergucate

SEPTEMBER 13, 2024

The hand x-ray shows punched out lesions with overhanging margins in the distal IP joints of index & middle fingers.

EMS 52

EMS 52