Ken Grauer, MD

OCTOBER 4, 2024

The ECG shown in Figure-1 was obtained from a previously healthy 30-year old man — who had this ECG as part of a "routine" pre-employment physical exam. He has had a few episodes of "dizziness" , but no syncope. He is otherwise well without medical problems. QUESTIONS: How would YOU interpret the ECG in Figure-1 ? How to evaluate this patient? Figure-1: The initial ECG in today's case. ( To improve visualization — I've digitized the original ECG using PMcardio ) MY Thoughts on the ECG in Figure-

EKG/ECG 257

EKG/ECG Wellness Research 257

The Trauma Pro

OCTOBER 1, 2024

In this day and age of ride-sharing apps like Uber and Lyft, it is possible to get a cheap ride virtually anywhere there is car service and a smartphone. And, of course, some people have used these services for transportation to the hospital instead of an ambulance ride. What might the impact of ride services on patient transport be for both patient and EMS?

Ambulance Services 130

Ambulance Services EMS Hospitals 130

Science Based Medicine

OCTOBER 2, 2024

Just recently, in casual conversation, someone commented to me that “they” already have a cure for cancer but are hiding it. This is a claim I frequently encounter. One survey, from 2005, found that 27.3% of those surveyed endorsed this belief. Another survey from 2014 found that 37% of people believe the FDA is suppressing natural cancer cures on behalf of “Big […] The post Conspiracy Thinking And Alternative Medicine first appeared on Science-Based Medicine.

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Sensible Medicine

OCTOBER 2, 2024

This post continues yesterday’s. If you have not read Part I, I suggest you read it first. Adam Cifu Sensible Medicine is a reader-supported publication. Please consider becoming a free or paid subscriber. There was a time when, right or wrong, there was a consensus within medicine regarding what kind of person would make a good doctor. It was believed that being a doctor meant you had to remember a great number of obscure things, and so we designed tests that heavily weighted memorization

Academics 112

Academics Wellness 112

RebelEM

OCTOBER 2, 2024

Take Home Points Toxic alcohols generally refer to methanol and ethylene glycol as these substances pose significant metabolic derangement and end-organ damage. Patient who present shortly after ingestion will simply look inebriated – no different than ethanol intoxication. At this point, patients will have an elevated osmolar gap and little to no anion gap.

EMS 108

EMS 108

The Trauma Pro

OCTOBER 4, 2024

Just about every practice guideline out there regarding liver and spleen injury has some physical activity restrictions associated with it. The accepted dogma is that moving around too much, climbing stairs, lifting objects, or getting tackled while playing rugby could exacerbate the injury and lead to complications or surgery. But is it true? Activity restrictions after solid organ injury have been around longer than I have been a trauma surgeon.

Pediatrics 147

Pediatrics Outcomes Operations Emergency Department 147

Science Based Medicine

OCTOBER 4, 2024

Dying of COVID is worse. The post If Dr. Jay Bhattacharya Saw What I Saw, He’d Realize That Being Called “Fringe” Isn’t So Bad After All first appeared on Science-Based Medicine.

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Dr. Smith's ECG Blog

OCTOBER 3, 2024

This was sent to me from Sam Ghali ( @EM_Resus ) with no other information. I assumed it was a patient with acute chest pain. "What do you think, Steve? Real or just fake?" What do YOU think? It has some inferior ST elevation with some reciprocal ST depression and inverted T in aVL. This usually indicates inferior OMI. My answer: "Fake: pretty certain, but not 100% certain.

EKG/ECG 104

EKG/ECG Wellness 104

American Medical Compliance

OCTOBER 3, 2024

Occupational Safety and Health Administration (OSHA) regulations are vital for maintaining a safe and healthy work environment in all industries. This includes dentistry. According to NSC Injury Facts, workplace injuries cost businesses $167 billion in 2021. As dental professionals, it’s crucial to understand and adhere to OSHA dental compliance standards to ensure the well-being of both staff and patients.

PPE 102

PPE Hazardous Materials Documentation/Coding Operations 102

First 10 EM

SEPTEMBER 30, 2024

Some topics come up over and over again, and it may seem somewhat repetitive or wasteful to spend so much time on them, but seeing as so many people are still using outpatient IV antibiotics despite overwhelming evidence that oral antibiotics are just as good, if not better, I will continue to cover papers as […] The post Oral antibiotics are noninferior to IV in pediatric bone and joint infections (obviously) appeared first on First10EM.

Pediatrics 105

Pediatrics EMS 105

Emergency Medicine Ireland

SEPTEMBER 30, 2024

Welcome back to the tasty morsels of critical care podcast. Today we look at quite a niche topic, that of chylothorax. We are used to many things in the pleural space, like simple fluid or blood or air but the presence of the myseterious substance chyle is a much more unusual and note worthy event. As a reminder of the basics which I of course knew implicitly and definitely did not have to resort to wikipedia to check… Chyle is largely formed in the small intestine as the gut transports fr

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Emergency Medicine Cases

OCTOBER 1, 2024

In this ECG Cases blog we look at 5 cases of ECGs falsely labeled 'normal'. Can you spot the critical abnormality? Written by Jesse McLaren; Peer Reviewed and edited by Anton Helman. October 2024 Five patients presented with ECGs labeled ‘normal’. Can you use systematic ECG interpretation to identify the [.] The post ECG Cases 51 – ECGs falsely labeled “normal” appeared first on Emergency Medicine Cases.

EKG/ECG 97

EKG/ECG EMS 97

Sensible Medicine

SEPTEMBER 30, 2024

JAMA-IM has published an observational study that sought causal effects from stopping blood-pressure-lowering drugs in older adults who were in long-term care. The UCSF-led team asked a specific question: did deprescribing of BP-lowering meds lessen cognitive decline? They didn’t write their question that specifically; instead they wrote that their purpose was to investigate the association of deprescribing antihypertensive medication with changes in cognitive function in nursing home resi

Stroke 100

Stroke Outcomes Hospitals 100

Dr. Smith's ECG Blog

OCTOBER 1, 2024

== MY Comment , by K EN G RAUER, MD ( 8/30 /2024 ): == I was sent the ECG shown in Figure-1 — knowing only that the patient was being seen in the ED ( E mergency D epartment ). How would you interpret this tracing? Figure-1: The initial ECG in today's case. MY Initial Thoughts: In my experience — all-too-many emergency providers fail to appreciate the potential contribution that a brief ( 1-to-2 line ) history may convey when interpreting arrhythmias.

EKG/ECG 92

EKG/ECG Shock EMS 92

EMDocs

OCTOBER 2, 2024

Authors: Lloyd Tannenbaum, MD (EM Attending Physician, Geisinger Wyoming Valley, PA); Mai Saber, DO (EM Attending Physician, Hackensack University Medical Center, NJ); Rachel Bridwell, MD (EM Attending Physician, Charlotte, NC) // Reviewer: Brit Long, MD (@long_brit) Hello and welcome back to ECG Pointers, a series designed to make you more confident in your ECG interpretations.

EKG/ECG 88

EKG/ECG EMS Emergency Department 88

Science Based Medicine

SEPTEMBER 30, 2024

[Editor note: Regular readers might—or might not have—noticed last Monday that, for the first time in more years than I can remember, I failed to post anything and didn’t even repost something from the archives or announce my absence. The explanation is unfortunately all too simple. The Sunday before, I spent something like 13 hours in the hall of at the emergency […] The post The NCCIH embraces the quackery that is “functional medicine” first appeared on Science-Based Medicine.

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Sensible Medicine

OCTOBER 1, 2024

What is valued in medical education and residency selection has changed enormously since I was a student. We used to value things that were easy to measure even if they had only a tenuous relationship to the ability to doctor. Now, we seem to be unable, or unwilling, to assess what we now value in students. Dr. Van Cleve writes about why letters of recommendation are not helpful in assessing residency applicants.

Wellness 99

Wellness Patient Safety Academics 99

EMCrit

SEPTEMBER 29, 2024

The HAPPEN Trial on NIPPV for AECOPD EMCrit Project by Scott Weingart, MD FCCM.

COPD 122

COPD 122

EMDocs

SEPTEMBER 30, 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’s video evaluates inhaled corticosteroids (ICS) for asthma in the ED setting. EBM Updates: Inhaled Corticosteroids for Asthma in the ED Background : Asthma is a common ED issue, with patient presentations ranging from needing a medication refill to severe exacerbation in respiratory failure.

Outcomes 83

Outcomes Documentation/Coding Academics Administration 83

Dr. Smith's ECG Blog

SEPTEMBER 29, 2024

A 50 yo was resuscitated from ventricular fibrillation. He had a prehospital ECG recorded after ROSC: What do you think? This certainly looks like an anterior STEMI (proximal LAD occlusion), with STE and hyperacute T-waves (HATW) in V2-V6 and I and aVL. Although one may have all kinds of ischemic findings as a result of cardiac arrest (rather than cause of cardiac arrest), this degree of ST elevation and HATW is all but diagnostic of acute proximal LAD occlusion.

EKG/ECG 77

EKG/ECG Wellness Academics Resuscitation 77

The Skeptics' Guide to EM

SEPTEMBER 28, 2024

Date: September 23, 2024 Reference: Essat et al. Diagnostic Accuracy of D-Dimer for Acute Aortic Syndromes: Systematic Review and Meta-Analysis. Annals of Emergency Medicine, May 2024 Guest Skeptic: Dr. Casey Parker is a Rural Generalist from Australia who is also an ultrasounder. Case: You are working a busy shift in a rural emergency department (ED) and your excellent Family Medicine trainee presents a case of a 63-year-old woman with chest pain and some intermittent radiation into the inter-s

Emergency Department 82

Emergency Department EKG/ECG Ultrasounds 82

Taming the SRU

OCTOBER 1, 2024

morbidity and mortality - r3 taming the sru - creating a unique pathway within academic emergency medicine - visual diagnosis - r2 cpc - r1 core content: penile disorders - r4 capstone morbidity and mortality conference WITH dr. shaw Motor Vehicle Accident and Tertiary Examinations A significant number of injuries in trauma patients are missed during the initial trauma assessment All trauma patients should have a structured tertiary exam performed that occurs after the initial resuscitative and

Dislocations 71

Dislocations Fractures Poisoning Academics 71

ALiEM

SEPTEMBER 30, 2024

A 23-year-old healthy male presented to the emergency department with left eye pain, soreness, and blurry vision after being hit in the left eye with a Nerf gun bullet two days prior. He had no prior ophthalmologic history and does not wear corrective lenses. Physical Exam Left eye : Visual acuity 20/30. Intraocular Pressure 17. Pupil 3mm, irregular, minimally reactive.

Academics 64

Academics Emergency Department 64

Emergency Medicine Cases

OCTOBER 1, 2024

In this EM Cases podcast Anton chats with Dr. Peter Brindley and Dr. Leon Byker who have a deep interest in the Culture of Medicine to explore what culture in medicine is, why culture is so important, and then drive home 10 strategies to improving the culture in our departments emphasizing the importance of human connection, empathy, open communication, and a willingness to learn from mistakes in creating a positive and fulfilling work environment, so that we love our work, we love our departmen

EMS 55

EMS Outcomes Teamwork 55

PDC Healthcare

OCTOBER 4, 2024

At PDC, we understand that precision and quality are essential in pharmacy operations. As we celebrate Pharmacy Week, we want to highlight our innovative labeling solutions designed to support the vital work pharmacists do every day. Whether you work in sterile compounding or manage patient-specific medications, PDC pharmacy label solutions are designed to meet your […] The post Celebrate Pharmacy Week with Advanced Labeling Solutions from PDC appeared first on connectID - PDC Healthcare B

Operations 52

Operations 52

Emergency Live

OCTOBER 4, 2024

Innovative Marche discovery promises to slow brain ageing An Italian research conducted by a team of scientists from INRCA and the Università Politecnica delle Marche has opened new perspectives in the fight against brain aging. Researchers have found that a simple nasal spray may be able to rejuvenate brain cells, improving memory and cognitive abilities. […] The post Nasal spray for a younger brain appeared first on Emergency Live.

Research 52

Research 52

Don't Forget the Bubbles

OCTOBER 2, 2024

Can’t get enough of Bubble Wrap? The Bubble Wrap Plus is a monthly Paediatric Journal Club reading list from Professor Jaan Toelen (University Hospitals Leuven) and Dr Anke Raaijmakers (Sydney Children’s Hospital). This comprehensive list is developed from 34 journals, including major and subspecialty paediatric journals. We suggest this list can help you discover relevant or interesting articles for your local journal club or allow you to keep a finger on the pulse of paediatric research.

Pediatrics 52

Pediatrics Hyperthermia / Hypothermia Emergency Department Urgent Care 52

PEMBlog

OCTOBER 2, 2024

In this episode of PEM Currents: The Pediatric Emergency Medicine Podcast , I explore the complexities of gastroesophageal reflux (GER) and gastritis in children and adolescents. I’ll make the important distinction between gastritis – which is diagnosed only via endoscopy – and dyspepsia, the term best used to describe the symptoms many patients experience.

Pediatrics 52

Pediatrics Emergency Department Ultrasounds Wellness 52

ETM Course

OCTOBER 1, 2024

The ETM team has been working hard to get the 2025 course calendar finalised and our 2025 course dates have now been announced. Course dates and registration details are available here. The the vast majority of our courses sell out well in advance. To avoid ending up on a waiting list, book your course place soon to avoid disappointment. To find out more about ETM Course, please visit the course information page here.

Wellness 52

Wellness 52

Emergency Live

OCTOBER 3, 2024

By 2027, a quarter of the world’s largest companies will actively hire people with neurodivergent abilities Artificial intelligence is revolutionizing the way we work, opening up new opportunities and requiring increasingly specialised skills. A recent Gartner study has revealed an unexpected but promising trend: by 2027, one-quarter of the world’s largest companies are planning to […] The post Neurodiversity and innovation: companies focus on neurodivergent skills appeared first on Emerge

Research 52

Research 52

Sensible Medicine

SEPTEMBER 30, 2024

Just a quick note to say that comments are turned back on for today’s and subsequent posts. Yes, we sometimes (strategically) turn off comments. And that’s all I will say about that. JMM Sensible Medicine is a reader-supported publication. To receive new posts and support my work, consider becoming a free or paid subscriber.

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PEMBlog

SEPTEMBER 30, 2024

Cannabis Hyperemesis Syndrome can make habitual smokers miserable! They will got some relief from hot showers – but many need fluids, ondansetron, topical capsaicin, and even Haldol. Lyrics [Chorus] Don’t fear the reefer? Cannabis hyper-emesis syndrome says you do Intractable vomiting, many hot showers What, oh what, will we do? [Verse] You didn’t think this would happen You just decided to smoke Now you’re puking your guts up Is this some sick kind of joke?

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Don't Forget the Bubbles

SEPTEMBER 29, 2024

Importance of Safety-netting Safety netting is crucial to ensure patients and parents have a clear plan to return when discharged if any concerning symptoms arise. A patient’s condition can change rapidly, and while they may be fit for discharge now, their health could deteriorate before it improves. Children are resilient and are generally fit and healthy.

Emergency Department 52

Emergency Department Dehydration Hospitals Fractures 52

Emergency Live

OCTOBER 3, 2024

New aDBS enables personalisation of treatment and improvement of patient status Parkinson’s disease is one of the most important neurological challenges of our time. In recent decades, deep brain stimulation (DBS) has revolutionized the management of this condition, providing significant relief to patients. However, scientific research has not stopped.

Research 52

Research 52

Board Bombs

SEPTEMBER 29, 2024

We guarantee you'll be able to treat this condition before ever being able to spell it (not to mention pronounce it). Let's quickly cover a not-so-rare high yield zoonotic infection! Want to experience the greatest in board studying? Check out our interactive question bank podcast- the FIRST of its kind here. Cite this podcast as: Briggs, Blake. 235.

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Dr. Mike Sevilla

SEPTEMBER 29, 2024

National Family Medicine Week #FamilyMedicineWeek is from September 29-October 5, 2024. This was announced last week at the American Academy of Family Physicians FMX conference last week in Phoenix. I’d like to recognize and thank all Family Physicians, residents, and medical students for their commitment to improving access to primary care for all.

Outcomes 52

Outcomes 52

EB Medicine

SEPTEMBER 29, 2024

In this special episode, Sam Ashoo MD and Rob Orman MD discuss the concept of Maladaptive Perfectionism and its application to emergency medicine. Understanding Maladaptive Perfectionism Case Example and Discussion Adaptive vs Maladaptive Perfectionism Personal Experiences and Legal Challenges Dealing with Negative Outcomes Strategies for Managing Perfectionism in the ED Handling Overwhelming Shifts Managing Expectations in the ED A Soul-Crushing Day in the ED Finding Meaning in Moments of Crisi

Outcomes 52

Outcomes 52