Ken Grauer, MD
SEPTEMBER 21, 2024
The ECG in Figure-1 was obtained from a previously healthy man in his early 20s — who initially presented with GI symptoms, that then evolved into CP ( C hest P ain ). The patient was thought to have anxiety. QUESTIONS: Given the above history — How would YOU interpret the initial ECG that is shown in Figure-1 ? Does the patient's age infuence your interpretation?
The Trauma Pro
SEPTEMBER 27, 2024
Preparation and planning will get you just so far. But then, you actually have to act. There are four phases in this procedure. I’ll break them down one by one. Patient preparation. The area should be shielded from curious onlookers and to control any airborne contaminants (dust, debris) at the scene. Portable monitors should be attached. Good IV/IO access needs to be in place, and the airway controlled via intubation.
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St. Emlyn
SEPTEMBER 26, 2024
St.Emlyn's - Emergency Medicine #FOAMed The diagnosis of subarachnoid haemorrhage in the emergency department is a constant source of anxiety. How do we make sure we pick up everyone with a bleed, but not overinvestigate […] The post The Subarachnoid Haemorrhage in the Emergency Department (SHED) Study appeared first on St.Emlyn's.
Dr. Smith's ECG Blog
SEPTEMBER 23, 2024
Written by Willy Frick with edits by Ken Grauer A woman in her 70s with a history of hypertension presented with acute onset shortness of breath. She was out walking her dog when she developed sudden dizziness and light-headedness. When EMS found her, she was dyspneic and diaphoretic. Her ECG is shown below: What do you think? The conventional machine algorithm interpreted this ECG as STEMI.
Sensible Medicine
SEPTEMBER 27, 2024
A great irony of Twitter/X, a site that epitomizes 21 st century ephemerality, is that it can also engender the persistence, or rebirth, of a work. On the one hand, studies that authors worked on for years, or essays that were wrestled with for weeks, are only tweeted for a day or two before disappearing into our collective amnesia. On the other, articles will sometimes find second life on the site.
The Trauma Pro
SEPTEMBER 24, 2024
We’ve covered all the preparation for field amputation. Now, it’s time to do it! But wait, exactly what equipment is needed? There are two principles that you must adhere to: figure it all out in advance, and keep it simple. It is crucial that the trauma program design and assemble equipment and drug packs in advance, otherwise critical equipment may not make it to the field.
St. Emlyn
SEPTEMBER 25, 2024
St.Emlyn's - Emergency Medicine #FOAMed This is the first of a series of blog posts on new research in emergency toxicology. We deal with all sorts of poisons here in Virchester, so be prepared for […] The post When is emergency endoscopy required for caustic ingestions? appeared first on St.Emlyn's.
Emergency Care Today brings together the best content for emergency care practitioners from the widest variety of industry thought leaders.
Science Based Medicine
SEPTEMBER 21, 2024
I think some respected newspapers could do a better job of being honest with their readers about some pretty basic and pretty important things. The post Open Letter to Pamela Paul of the New York Times: Watch Some Interviews With Dr. Marty Makary. They Are More Important Than Peanut Allergies. first appeared on Science-Based Medicine.
Greater Sydney Area HEMS
SEPTEMBER 22, 2024
Hello and welcome back to The Sydney HEMS Debrief, episode 15! It has been a while since our last episode, and today we are back with the Pre-Care team to discuss this world-leading trial. Joining us are Nat, Jackie, Andrew and Pete. Together, we will discuss the experiences of clinicians involved in this trial, specifically highlighting the importance of maintaining good ALS prior to the arrival of, as well as during the presence of, the pre-care team as well as how the pre-care trial is impact
Emergency Medicine Journal
SEPTEMBER 25, 2024
Background Emergency Medical Services (EMS) studies have shown that prehospital risk stratification and triage decisions in patients with suspected non-ST-elevation acute coronary syndrome (NSTE-ACS) can be improved using clinical risk scores with point-of-care (POC) troponin. In current EMS studies, three different clinical risk scores are used in patients suspected of NSTE-ACS: the prehospital History, ECG, Age, Risk and Troponin (preHEART) score, History, ECG, Age, Risk and Troponin (HEART) s
EM Literature of Note
SEPTEMBER 24, 2024
The cornerstone of treatment for severe exacerbations of chronic obstructive pulmonary disease remains non-invasive positive pressure ventilation. Typically, this involves bi-level positive pressure settings, preventing alveolar collapse while assisting with inspiration and gas exchange. This works – most of the time. When it doesn’t work – endotracheal intubation.
Sensible Medicine
SEPTEMBER 23, 2024
We often forget this but clinical trials are experiments on humans. To minimize risks to participants, trials have independent oversight boards that make recommendations on stopping trials early. A typical example is when one group in the trial shows obviously better results. The group of experts judge whether it would be ethical to continue the trial—because if the effect is so much better in one arm of the trial, the other arm is getting inferior care.
ECG Guru
SEPTEMBER 23, 2024
Extract from a Holter ECG, 2 continuous strips, recorded at 25 mm/s. At the top you can see a broad complex tachycardia without recognizable P waves, which ends spontaneously after 2 beats in the lower section. This is a VT. The very first beat in the 1st strip is most probably a fusion beat. After the end of the VT in the 2nd strip, a narrow QRS complex appears, here you can also recognize that atrial fibrillation is present.
The Skeptics' Guide to EM
SEPTEMBER 21, 2024
Date: September 18, 2024 Reference: Dillon et al. Naloxone and Patient Outcomes in Out-of-Hospital Cardiac Arrests in California. JAMA Network Open. August 20, 2024 Guest Skeptic: Dr. Chris Root is an emergency medicine and emergency medicine service (EMS) physician at the University of New Mexico, Albuquerque. Before attending medical school, he was a New York City Paramedic.
Science Based Medicine
SEPTEMBER 27, 2024
Biosafety Now is fine working with a pro-virus, misinformation doctor to prevent a potential pandemic. What about a doctor who worked with patients and countered misinformation during an actual pandemic? The post A “Biosafety” Organization Partnering With Dr. Jay Bhattacharya To Guard Against Viruses Is Like A Zebra Teaming Up With A Lion To Promote Vegetarianism first appeared on Science-Based Medicine.
First 10 EM
SEPTEMBER 23, 2024
If I am honest, on most of my shifts, other substances seem to be far more destructive than nicotine. I spend a lot of time talking to patients about suboxone, or dealing with the consequences of alcohol. I definitely talk to people about smoking, but aside from brief counseling and occasionally prescribing nicotine replacement for […] The post Smoking cessation in the emergency department (The COSTED trial) appeared first on First10EM.
EMDocs
SEPTEMBER 24, 2024
Today on the emDOCs cast with Brit Long ( @long_brit) , we cover eclampsia. Episode 107: Eclampsia Definition: Severe hypertensive disease of pregnancy (HDP) with new onset tonic-clonic, focal, or multifocal seizures or unexplained altered mental status in a patient who is pregnant or postpartum and there’s no other causative etiologies. Eclampsia can occur during or after the 20th week of pregnancy and up to 6 weeks postpartum. 60% of cases occur during the antepartum period, 20% intrapartum, a
Sensible Medicine
SEPTEMBER 26, 2024
This debate stems from a long running conversation between Vinay and Adam. The conversation was provoked by tweets in which doctors shared their mental health struggles. We have seen tweets about anxiety disorders, suicide attempts, and psychiatric drug dosing. What underlies the conversation is a simple question: Should Doctors Voice Their Own Mental Illness?
American Medical Compliance
SEPTEMBER 23, 2024
Caregiving is an inherently demanding profession, especially within assisted living facilities, where caregivers must balance the dual responsibilities of delivering high-quality care and managing their own emotional and physical well-being. The Alzheimer’s Association’s 2024 Alzheimer’s Disease Facts and Figures report highlights that 70% of dementia caregivers find coordinating care to be a significant source of stress.
PulmCCM
SEPTEMBER 26, 2024
Hey! She has anaphylaxis, you idiot! Drop the camera and call 911! The U.S. FDA approved an epinephrine nasal spray in August, the first nasal spray approved to treat anaphylaxis. The preparation will be marketed as neffy (all lowercase, so cute!), and is approved for adults and children weighing at least 30 kg (66 pounds). Neffy was approved based on four studies in 175 adults that demonstrated similar concentrations of blood epinephrine after spraying neffy as with approved epinephrine injecti
Science Based Medicine
SEPTEMBER 26, 2024
We are more likely to use an ineffective treatment after slight symptom improvement, even when the changes are coincidental. The post Post Hoc Bias in Medicine first appeared on Science-Based Medicine.
EMDocs
SEPTEMBER 26, 2024
Here’s another case from Medical Malpractice Insights – Learning from Lawsuits , a monthly email newsletter for ED physicians. The goal of MMI-LFL is to improve patient safety, educate physicians and reduce the cost and stress of medical malpractice lawsuits. To opt in to the free subscriber list, click here. Stories of med mal lawsuits can save lives.
Stop and Think
SEPTEMBER 22, 2024
Hi everyone. I’ve been stunned about all the new subscribers. I am not sure what happened, but thank you for signing up. I’ve had a busy late summer writing and podcasting—as well as practicing electrophysiology here in beautiful Louisville Kentucky. Let’s start with a (possible) change of opinion. I wrote in July of this year that my colleagues in heart rhythm medicine might be too easily impressed with new technology.
ECG Guru
SEPTEMBER 23, 2024
Unfortunately, I can't remember who the author of this ECG is. Perhaps he/she will get in touch with me. However, the ECG is very nice (despite the less than optimal recording quality) and that's why I want to post it. I don't know the history. In the first section of the ECG we see coarse fibrillation waves and QRS complexes with very different RR intervals, which is why this is atrial fibrillation.
Science Based Medicine
SEPTEMBER 25, 2024
Myopia, or near-sightedness, has been steadily on the rise over the last half-century. A recent systematic review updates the literature on the extent and nature of this epidemic. Let’s get straight to the findings and then discuss what this means. The reviews includes: “276 studies, involving a total of 5,410,945 participants from 50 countries across all six continents.” The researchers find a […] The post Myopia Epidemic first appeared on Science-Based Medicine.
EMCrit
SEPTEMBER 23, 2024
All things Vascular Access with the Vascular Guy EMCrit Project by Scott Weingart, MD FCCM.
RebelEM
SEPTEMBER 23, 2024
Bottom Line Up Top: Based on the available evidence, we should strongly consider ketamine over etomidate as our default induction agent in critically ill patients. Clinical Scenario: A 48 year old man presents with fever, hypotension, hypoperfusion and hypoxemia. Workup reveals multifocal pneumonia and oxygenation only marginally improves with non-invasive ventilation.
Dr. Smith's ECG Blog
SEPTEMBER 25, 2024
Submitted by Dr. George Mastoras (Twitter @georgemastoras), written by Jesse McLaren It’s a busy day in the ED when you’re sent another ECG to sign off from a patient at triage. A healthy 45-year-old female presented with chest pain, with normal vitals. The computer interpretation was “ST elevation, consider early repolarization, pericarditis or injury.
The Bottom Line
SEPTEMBER 24, 2024
What’s new in the Critical Care literature – monthly updates
PEMBlog
SEPTEMBER 26, 2024
PEMPix is the American Academy of Pediatrics Section on Emergency Medicine’s annual visual diagnosis competition. This year, in addition to the 10 finalists Maneesha Agarwal will be presenting at the National Conference and Exhibition we will be sharing four cases online in advance of the conference. This is the last of the four cases. This case was submitted by Dr.
NRC Health
SEPTEMBER 25, 2024
A recent NRC Health webcast discussed the intersection of artificial intelligence (AI) and empathy in healthcare. Check out the key takeaways and watch the webcast on demand today. The post AI and the future of Human Understanding in healthcare appeared first on NRC Health.
ALiEM
SEPTEMBER 25, 2024
A 24-year-old male with a history of microscopic hematuria presented to the emergency department (ED) with left lower quadrant abdominal pain. His pain started about two weeks ago and has been intermittent. He describes the pain as stabbing. He decided to come to the ED today because of the persistent nature of the pain. He denies chest pain, cough, shortness of breath, fevers, nausea, vomiting, diarrhea, constipation, rectal bleeding, dysuria, and increased urinary frequency.
The Bottom Line
SEPTEMBER 24, 2024
What’s new in the Critical Care literature – monthly updates
PEMBlog
SEPTEMBER 24, 2024
EmergiQuiz is an annual case-based presentation sponsored by the AAP Section on Emergency Medicine that challenges the audience to think through the differential diagnosis for four amazing cases. Traditionally these cases are presented live at the AAP National Conference and Exhibition. Since 2020 the AAP Section on Emergency Medicine has also been sponsoring the publication of online cases on EmergiQuiz.com.
AED Leader
SEPTEMBER 27, 2024
Imagine this scenario: your day is unfolding as usual, when suddenly, someone near you falls down. Their heart has ceased to function properly – they’re undergoing cardiac arrest. It’s an alarming proposition, right? However, it’s an incident that could occur to anyone, at any place. Hence, understanding the significance of defibrillation could be a life-altering factor.
Emergency Live
SEPTEMBER 27, 2024
Alarm issued concerning several lots of iceberg salad, with presence of Listeria monocytogenes The Ministry of Health recently issued an alert concerning several lots of iceberg salad, urging consumers to return their purchased products. The cause of this measure is the presence of Listeria monocytogenes, a pathogenic bacterium known to contaminate food and cause serious […] The post Withdrawal of lots of iceberg salad: risk of listeriosis appeared first on Emergency Live.
PulmCCM
SEPTEMBER 27, 2024
Tenecteplase is a modified version of tissue plasminogen activator (alteplase), with a higher affinity for binding to fibrin and a longer half-life. TNK can be pushed as a single intravenous bolus, making it easier to administer than alteplase (10% of which is infused over one minute, followed by the other 90% over 60 minutes).
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