Ken Grauer, MD

SEPTEMBER 15, 2023

The tracing in Figure-1 was sent to me for my interpretation. As per the title of today's Blog post — There is no simple explanation for all that is happening in this challenging tracing. Are YOU up for the challenge? I found that the most challenging part of today's tracing is determining the etiology of beat "X". As I explain below — I think it unlikely that beat "X" represents a single, slightly accelerated junctional beat.

EKG/ECG 248

EKG/ECG Academics Wellness 248

The Trauma Pro

SEPTEMBER 14, 2023

There is an art to deciding when to place a chest tube for either hemothorax or pneumothorax. For the most part, the trauma professional examines the imaging and then uses some unknown internal metric to declare that it is “too big.” Then it’s time to insert some type of chest drain. There have been attempts over the years to make this decision more quantitative.

Resuscitation 162

Resuscitation Hospitals Wellness 162

RebelEM

SEPTEMBER 14, 2023

Background: Cardiogenic shock develops in up to 10% of patients with acute myocardial infarction (AMI) and carries a 30 day mortality rate around 50%. Revascularization of the culprit lesion remains one of the few established treatments though there are numerous other unproven modalities including extracorporeal life support (ECLS). Many centers have attempted ECLS to achieve hemodynamic stabilization in this group of patients.

Shock 137

Shock Outcomes Resuscitation Stroke 137

Science Based Medicine

SEPTEMBER 12, 2023

Doctors who repeatedly predicted herd immunity in 2020 and 2021, mocking and berating those who disagreed, now treat herd immunity as a taboo phrase. The post When Did “Herd Immunity” Become a Taboo Phrase? first appeared on Science-Based Medicine.

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132

Don't Forget the Bubbles

SEPTEMBER 13, 2023

The Choosing Wisely ® campaign is an initiative that promotes collaborative conversations between clinicians and families to safely avoid unnecessary and potentially harmful tests. The American Academy of Paediatrics Section on Emergency Medicine (AAP SOEM) created a list of five key recommendations for Paediatric Emergency Medicine after a structured review process and expert consensus opinion.

Seizures 131

Seizures Pediatrics Emergency Department Radiology 131

The Trauma Pro

SEPTEMBER 15, 2023

Venous thromboembolic disease (VTE) continues to be a major issue in trauma patients. Most trauma centers have prophylaxis guidelines to try to reduce this problem. These guidelines typically recognize specific injuries that increase the risk of bleeding if anticoagulants are given. Typical ones include hemorrhagic injuries to the brain, pelvic and spine fractures, and solid organ injuries.

Administration 147

Administration Fractures Wellness 147

Dr. Smith's ECG Blog

SEPTEMBER 15, 2023

I came to work one day and one of my partners said, "Hey, Steve, we had a STEMI this afternoon!" I said, "Cool, can I see the ECG?' Of course he said: "Yes, it was a 60 year old diabetic with Chest pain." So he showed me the ECG recorded in triage: What did I say? "That is not a STEMI. That is Arterial Pulse Tapping Artifact (APTA)." He said: "What?

EKG/ECG 129

EKG/ECG Wellness 129

ACEP Now

SEPTEMBER 11, 2023

Ben Mattingly, MD, tries to live by the adage, “One should be adventurous and daring, but not reckless.” The challenge is that the line between adventurous and reckless is often paper-thin. Take, for example, his recent expedition to Nepal to summit Mount Everest. When he arrived at the base camp, he found out three rope-fixing sherpas had just been killed in the famously dangerous Khumbu Icefall.

Wellness 126

Wellness 126

The Trauma Pro

SEPTEMBER 13, 2023

Blunt vehicular trauma is the most common cause of severe lower extremity trauma, particularly motorcycle crashes. Occasionally, the injury is so severe that the limb cannot be saved, and amputation is necessary. The conventional treatment is to protect the amputation incision, provide physical therapy, and fit a prosthesis once the stump is mature.

Soft Tissue Injuries 147

Soft Tissue Injuries Operations Wellness 147

The Skeptics' Guide to EM

SEPTEMBER 9, 2023

Reference: Snelling et al. Ultrasonography or radiography for suspected pediatric distal forearm fractures. New England Journal of Medicine June 2023 Date: July 19, 2023 Guest Skeptic: Dr. Casey Parker is a Rural Generalist that includes in his practice emergency medicine, anesthesia, and critical care. He is also a fully-fledged ultrasonographer. Casey currently splits his time […] The post SGEM#415: Buckle Down for some Ultrasound to Diagnosis Distal Forearm Fractures first appeared on The Ske

Fractures 124

Fractures Ultrasounds Pediatrics Outcomes 124

First 10 EM

SEPTEMBER 11, 2023

This is a guest post by Dr. Lanujan Kaneswaran. Lanujan is a second-year Family Medicine resident at the University of Toronto. He has a background in medical health informatics and machine learning. His areas of interest include artificial intelligence and machine learning in medicine, and health equity through advocacy and technology. When managing atrial fibrillation […] The post Can we use D-dimer to assess for left atrial clot in atrial fibrillation?

Stroke 123

Stroke 123

Emergency Medicine Cases

SEPTEMBER 12, 2023

In this ECG Cases blog Dr. Jesse MacLaren guides us through 10 cases of patients who present with generalized weakness or acute neurologic symptoms and discusses how to look for ECG signs of dysrhythmias, electrolyte emergencies, acute coronary occlusion, and demand ischemia in patients with generalized weakness and in patients with neurologic symptoms, to consider predisposing factors like LVH; seizure-like activity from cardiac syncope; TIA/CVA embolic sources like atrial fibrillation or LV th

EKG/ECG 118

EKG/ECG Seizures Stroke EMS 118

The Trauma Pro

SEPTEMBER 12, 2023

The 82nd Annual Meeting of the American Association for the Surgery of Trauma begins next week. As is my custom, I will be reviewing some of the more interesting (to me) oral presentation abstracts until the last day of the meeting. When reading abstracts, keep in mind that you are seeing just a snippet of a finished manuscript. The authors are given very little print space to fully describe their research idea, their methods, and their results’ significance.

Fractures 147

Fractures Head Injuries Research Outcomes 147

Don't Forget the Bubbles

SEPTEMBER 11, 2023

5-year-old Willow arrives in the ED at 3 a.m. Her mum says she has been waking up screaming on the last few nights, clutching her vulval area and saying it hurts. Her parents have noticed she is scratching her bottom a lot, too, and they’ve had an email from school saying there are cases of threadworms in the reception class. Threadworms ( Enterobius vermicularis , also known as pinworms or seatworms) are the most common helminthic infection in the Western World.

Wellness 116

Wellness 116

EM Literature of Note

SEPTEMBER 11, 2023

Well, PRISMS demonstrated unfavorable results. MARISS tried to ascertain predictors of poor outcome in mild stroke, and intravenous thrombolysis was not associated with an effect on the primary outcome. Now, again, we examine thrombolysis in “mild” stroke, in this case, NIHSS ≤3 – and fail. Like MARISS, this is a retrospective dredge of patients selected by the treating clinicians to receive either intravenous thrombolysis or, in this case, dual-antiplatelet therapy with clopidogrel

Stroke 112

Stroke Outcomes Wellness 112

Emergency Live

SEPTEMBER 14, 2023

David Crouch, world-renowned CBRNe expert, will discuss the benefits of the PEERS initiative In anticipation of the upcoming workshop on September 29, PEERS Project is delighted to introduce you to one of our distinguished speakers, David Crouch. He currently serves as the CBRNe (Chemical, Biological, Radiological, Nuclear, and Explosives) Expertise Leader at TFC Research and Innovation […] The post David Crouch will discuss the latest trends in CBRNe appeared first on Emergency Live.

Radiology 111

Radiology Radiology Research 111

Sensible Medicine

SEPTEMBER 15, 2023

I released this on my own substack, but honestly think the readers of Sensible Medicine should know this. If your chair tells you to not talk to the press, the chair should be fired. I was recently reading Jay Bhattacharya’s first person account of his treatment at Stanford— the vicious disputes about lockdown in the Spring of 2020— and this jumped out at me.

CDC 112

CDC Academics Administration 112

Medagadget

SEPTEMBER 12, 2023

Researchers at the University of Washington School of Medicine have developed a method to create stem cell-derived organoids that can produce tooth enamel proteins. The breakthrough could pave the way for lab grown enamel that can be used in dental repairs and may even allow for living fillings or completely new living teeth that can be implanted into a patient’s jaw.

Research 106

Research 106

RebelEM

SEPTEMBER 13, 2023

Take Home Points: Airway management is paramount; expect a challenging intubation and consider controlling the airway early if there is apparent airway compromise. Understanding the cause of angioedema (mast cell vs. bradykinin mediated) helps dictate directed management. Urticaria and pruritus = MAST CELL mediated, which is treated like a standard allergic reaction.

Allergic Reactions 105

Allergic Reactions Airway Management Anaphylaxis Emergency Department 105

Emergency Live

SEPTEMBER 15, 2023

Dogs and humans united to save lives in the water The ‘Scuola Italiana Cani da Salvataggio’ (SICS) is an outstanding organisation, both nationally and internationally, dedicated to the training of dog units specialised in water rescue. Founded in 1989 by Ferruccio Pilenga, SICS has contributed significantly to the safety of people in Italian waters and […] The post SICS: A Story of Courage and Dedication appeared first on Emergency Live.

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Sensible Medicine

SEPTEMBER 11, 2023

Investigators from Leipzig Germany called the trial ECLS-SHOCK. It studied the use of extracorporeal life support in patients with cardiogenic shock due to acute myocardial infarction. ECLS-SHOCK delivered shocking results. First some background. Cardiogenic shock is medical jargon to describe the really bad situation when the heart cannot deliver enough blood to the body.

Shock 111

Shock Outcomes 111

Broome Docs

SEPTEMBER 9, 2023

This month I am back on the SGEM podcast – this time on the all new Paeds section with Dr Dennis Ren. In this episode we do a deep dive into the BUCKLED trial that looked at the use of bedside ultrasound vs. plain film X-rays for the initial investigation of paediatric forearm fractures. This is a really neat Australian trial run by my friend Dr Peter Snelling and friends in Queensland.

Fractures 114

Fractures Ultrasounds Outcomes 114

Medagadget

SEPTEMBER 14, 2023

Researchers at the University of California San Francisco have developed a brain computer interface that can lets someone with severe paralysis communicate with both speech and facial expressions, in the form of a digital avatar. The breakthrough advances what has been possible, with previous brain computer interface systems providing speech only, and allows people to communicate more completely, encompassing facial expressions, which are an important aspect of natural communication.

Research 99

Research 99

Emergency Live

SEPTEMBER 13, 2023

EIL Systems presents the new ‘Towerlux Hybrid Power’ light tower: lighter, more powerful and portable In a world where innovation drives progress, EIL Systems stands as a beacon of light, pioneering the creation of technological solutions designed to tackle emergencies with a revolutionary approach. Its latest product, the Towerlux Hybrid Power light towers, is transforming […] The post EIL Systems: emergency lighting at REAS 2023 appeared first on Emergency Live.

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105

Core Medical Group

SEPTEMBER 15, 2023

Meet our Allied Team Lead with 2.5 years of dedication and commitment, James. His exceptional journey in the healthcare recruitment world has earned him the role as team lead after his 16 years of service. With an impressive background in the United States Coast Guard and a passion for helping professionals find their perfect healthcare roles, James brings a unique perspective to the world of healthcare recruitment.

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96

Science Based Medicine

SEPTEMBER 13, 2023

Researchers create an embryo model from human embryonic stem cells. The post Complete Human Embryo Model Made From Stem Cells first appeared on Science-Based Medicine.

Research 97

Research 97

Medagadget

SEPTEMBER 14, 2023

Researchers at the Harvard Wyss Institute have developed a technique that lets clinicians to characterize and monitor melanoma. The system involves using a microneedle patch that can draw deep interstitial fluid into itself through a series of penetrating hyaluronic acid needles. The needles can later be dissolved to release the biomarkers into a test tube before analysis, using a highly sensitive technique called Simoa, to detect individual biomarker protein molecules.

Research 99

Research Ultrasounds Wellness 99

Emergency Live

SEPTEMBER 12, 2023

Cyclone Daniel: over 2,000 dead and thousands missing in Libya The national president of the Italian Red Cross, Rosario Valastro, has launched an urgent appeal for international solidarity in response to the devastating cyclone Daniel that has hit north-east Libya. With over two thousand dead and thousands missing, the situation is critical, and the CRI […] The post Disaster in Libya, the Italian Red Cross in the front line for assistance appeared first on Emergency Live.

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105

Taming the SRU

SEPTEMBER 15, 2023

ultrasound grand rounds: bedside dvt studies - family presence in the ed/icu - r1 clinical knowledge: aicd - r3 small groups: difficult airway management Ultrasound grand rounds: DVT studies WITH Dr. minges Why should we perform bedside DVT studies in the ED? Limited availability of radiology-performed US services in certain hospitals, especially overnight Can avoid unnecessary anticoagulation in patients Reduce time in ED to disposition In terms of workflow, when there is suspicion for a DVT, y

CPR 89

CPR Burns Airway Management Wellness 89

Emergency Medicine Cases

SEPTEMBER 12, 2023

On this month's EM Quick Hits podcast: Anand Swaminathan on the role of methylene blue in septic shock, Nour Khatib on jaw dislocation reduction techniques, Hans Rosenberg on a phenotypic approach to Crohn's disease emergencies, Gil Yehudaiff on evidence based analgesics in renal colic, Brit Long on the importance of inhaled steroids for asthma, and Andrew Petrosoniak on the "lethal diamond" in polytrauma patients and the current state of hypocalcemia in bleeding trauma patients.

Dislocations 87

Dislocations Shock EMS Sepsis 87

Medagadget

SEPTEMBER 14, 2023

Researchers at the National University of Singapore have developed a highly sensitive pressure sensor that can provide haptic feedback for surgeons using laparoscopic tools or for use in robotic grippers as part of robotic surgical systems. The technology is inspired by the surface of the lotus leaf, which is extremely sensitive to the pressure exerted by tiny drops of water and will repel them.

Research 93

Research Operations Outcomes Wellness 93

Emergency Live

SEPTEMBER 11, 2023

Earthquake in Morocco: relief efforts amid difficulties and needs In south-western Morocco, a tragedy of devastating proportions shook the country in the night between Friday 08 and Saturday 09 September 2023. A 6.8 magnitude earthquake killed over two thousand people and left thousands of others without a roof to shelter under. The Atlas mountain range, […] The post Morocco: local and international rescuers working to save victims appeared first on Emergency Live.

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Sensible Medicine

SEPTEMBER 13, 2023

I grew up in a clinic. My mom (a pediatrician) and my uncle (a cardiologist) both had offices in the basement of our two-family home in Brooklyn. When the first floor tenants moved out, my dad (a vascular surgeon) opened an ambulatory surgery center in that apartment. Looking back, my childhood home was practically a clinic. My parents are baby boomers, born as first-generation Americans.

Leadership 87

Leadership Wellness 87

Science Based Medicine

SEPTEMBER 15, 2023

Did an absurdly spicy chip and a social media challenge kill a Massachusetts teen? His family sure thinks so, and it is possible. But skepticism is appropriate unless further details emerge. Still, these chips aren't for kids. The post Did a Spicy Social Media Challenge Kill a Massachusetts Teen? first appeared on Science-Based Medicine.

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81

Medagadget

SEPTEMBER 12, 2023

Researchers at Stanford University have developed a new type of cancer therapy. The technology targets mucins, sugar-coated proteins that help cancer cells to metastasize and avoid the immune system. In particular, mucins enable cancer cells to survive free-floating as they travel through the blood during metastasis and can also trick immune cells into assuming that the cancer cell is not a threat.

Research 90

Research 90

Emergency Live

SEPTEMBER 12, 2023

Damage, isolation, aftershocks: the consequences of earthquakes If there is one event for which one always has a developed a certain fear, it is the earthquake. Earthquakes can pop up anywhere, whether in the deepest seas or even in areas completely removed from the most populated ones. A recent example is the earthquake that, unfortunately, […] The post The aftermath of earthquakes - what happens after the tragedy appeared first on Emergency Live.

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105

Dr. Smith's ECG Blog

SEPTEMBER 10, 2023

Sent by anonymous, edited by Pendell Meyers A man in his 50s with history only of hypertension presented with acute chest pain that started 45 minutes prior to presentation while doing yard work. It radiated to both shoulders and both upper extremities, and there was shortness of breath and diaphoresis as well. He reported a normal stress test a few years ago.

EKG/ECG 78

EKG/ECG Outcomes Academics Documentation/Coding 78