Ken Grauer, MD

MAY 31, 2024

I was sent the ECG in Figure-1 — without the benefit of any history. Is this VT? What is the 1st thing — that YOU would do? Figure-1: I was sent this ECG without any history. Is this VT? MY Thoughts on Today’s CASE: As tempting as it might be to reach for the defibrillator on seeing the ECG shown in Figure-1 — My initial reaction was different. At 1st glance , my impression from seeing ECG #1 — was that the rhythm is very fast and irregular — with a highly variable QRS morphology — and, without

Shock 414

Shock EKG/ECG Seizures 414

The Trauma Pro

MAY 28, 2024

I’ve covered the problem of performing MRI on patients with external fixators. This is typically a problem that arises in head-injured patients with extremity or pelvic fixators for concomitant fractures. MRI is an indispensable tool for the evaluation of head, spine, and soft tissue trauma. However, a great deal of effort is required to ensure that any patient scheduled for this test is “MRI compatible.

Fractures 230

Fractures Hospitals 230

Sensible Medicine

MAY 25, 2024

Imagine if your car mechanic took $10,000 a year from Michelin tires for “consulting” and then tended to recommend their tires over Pirelli — even if the latter are on sale or better quality or both. Imagine if your Governor took campaign contributions from Panera bread and then strangely exempted Panera bread from the new minimum wage law.

Academics 145

Academics Poisoning Research Wellness 145

RebelEM

MAY 27, 2024

Background: The REVERT Randomized Controlled Trial demonstrated the superiority of the modified valsalva maneuver (MVM) over the standard valsalva maneuver (VM) in re-establishing normal sinus rhythm (NSR) in patients with PSVT (Appelboam 2015). MVM exaggerates venous return to the heart and increases vagal outflow by elevating the patient’s legs.

Outcomes 137

Outcomes Research Hospitals Operations 137

Ken Grauer, MD

MAY 28, 2024

I recently recorded a series of 4 podcasts regarding KEY concepts in ECG interpretation. Easy LINKS — tinyurl.com/KG-ECG-Podcasts — [link] — Other ECG Audio PEARLS I previously made for my ECG Blog can be found in the right column of each page on this blog just below this icon — under, "ECG Audio PEARLS". My New E CG P odcasts ( 5/28/2024 ): These podcasts are part of the Mayo Clinic Cardiovascular CME Podcasts Series ( "Making Waves" ) — hosted by Dr.

EKG/ECG 367

EKG/ECG Wellness 367

The Trauma Pro

MAY 31, 2024

Call me slow. I’ve subconsciously seen those capital letters in drug names for years. But I never really paid attention or thought much about them. For whatever reason, I just now realized that they are EVERYwhere! So I decided to investigate. Technically, they are called tall man letters. Here are some examples: Certain parts of the drug name are capitalized to highlight differences from a drug with similar spelling.

147

147

Sensible Medicine

MAY 28, 2024

Regardless of the reason for a primary care visit in the United States, patients are routinely asked how often they feel “hopeless” or "like a failure” These questions come from the PHQ-9. The PHQ-9 has since been validated and is now widely used to screen for depression. Since the United States Preventive Services Task Force (USPSTF) first recommended depression screening 22 years ago, the practice has become standard in primary care despite an absence of evidence.

Outcomes 137

Outcomes Military Psychiatric Wellness 137

Dr. Smith's ECG Blog

MAY 27, 2024

Written by Jesse McLaren, with a very few edits by Smith A 60-year-old presented with chest pain. The ECG did not meet STEMI criteria, and the final cardiology interpretation was “ST and T wave abnormality, consider anterior ischemia”. But are there any other signs of Occlusion MI? There’s only minimal ST elevation in III, which does not meet STEMI criteria of 1mm in two contiguous leads.

EKG/ECG 118

EKG/ECG Documentation/Coding Emergency Department 118

Science Based Medicine

MAY 27, 2024

I've long argued that antivax beliefs, indeed all science denial, is conspiracy theory. Leave it to The Brownstone Institute's Jeffery Tucker to make my point better for me than I ever could. Of course, Brownstone was always going to "go there." The post The ultimate COVID-19 antivax conspiracy theory, courtesy of The Brownstone Institute and Jeffery Tucker first appeared on Science-Based Medicine.

111

111

First 10 EM

MAY 27, 2024

We have previously discussed the many pharmaceutical advertisements published by the New England Journal of Medicine, thinly disguised as science, such as the original open label uncontrolled look at andexanet alfa. (Connolly 2019) At that point, I concluded that andexanet alfa should clearly not be used (although our pharmacies didn’t listen and wasted a lot […] The post Andexanet alfa: expensive and harmful?

EMS 113

EMS 113

EM Ottawa

MAY 30, 2024

In this month’s PTM Journal Club, we explored the most recent literature on trauma care in the pre-hospital setting. If you missed last months PTM Journal Club, make sure to check-it out by clicking HERE. Ketamine vs Morphine for Out-Of-Hospital Traumatic Pain Background and Objectives Inadequate analgesia is a common challenge in the out-of-hospital treatment […] The post PTM Journal Club: Trauma Care appeared first on EMOttawa Blog.

Hospitals 106

Hospitals Ultrasounds 106

Dr. Smith's ECG Blog

MAY 25, 2024

An elderly dialysis patient presented with chest pain. She has poor LV function. Previous echo 4 months ago (confirmed with ED bedside echo): The estimated left ventricular ejection fraction is 30%. Severely decreased LV function. Regional wall motion abnormality-inferior, inferolateral, septum, anterolateral, anterior and apex, lateral. Here is her ECG: Regular Wide Complex Tachycardia.

EKG/ECG 119

EKG/ECG 119

RebelEM

MAY 29, 2024

Take Home Points: Posterior epistaxis is a rare, life-threatning presentation. The key is in identifying and rapidly gaining control with a posterior pack or foley catheter. These patients often require surgical intervention so get ENT to the bedside and admit to a place with a higher level of monitoring. REBEL Core Cast 123.0 – Posterior Epistaxis Click here for Direct Download of the Podcast.

PPE 105

PPE EMS Hospitals Wellness 105

Emergency Live

MAY 30, 2024

Understanding Multiple Sclerosis: Understanding the Disease Multiple sclerosis (MS) is a chronic disease in which the immune system attacks nerve fibers in the brain and spinal cord. MS affects the myelin sheath that covers nerve fibers, resulting in a variety of different effects in terms of neurological symptoms. Among the most common outcomes are vision […] The post World Multiple Sclerosis Day appeared first on Emergency Live.

Outcomes 98

Outcomes 98

St. Emlyn

MAY 27, 2024

St.Emlyn's - Emergency Medicine #FOAMed This JC from St Emlyn's looks at a paper from SJTRM and explores the association between first-pass success (FPS) during pre-hospital intubation and 30-day mortality in patients treated by Finnish helicopter emergency medical services (HEMS). The post JC: Is First Pass Success an important outcome in PHEA research?

Research 106

Research Outcomes Hospitals 106

Dr. Smith's ECG Blog

MAY 29, 2024

Written by Pendell Meyers Two patients with acute chest pain. Do either, neither, or both have OMI and need reperfusion? Patient 1: Patient 2: Patient 1: A man in his 40s with minimal medical history presented with acute chest pain radiating to his R shoulder. Triage ECG: Click here to sign up for Queen of Hearts Access Three serial troponins were all undetectable.

EKG/ECG 100

EKG/ECG 100

Emergency Medicine Journal

MAY 28, 2024

Clinical introduction An octogenarian presented to the hospital post-fall from a bed, sustaining left facial and chest bruises without consciousness loss. He had diabetes, hypertension, stroke and atrial fibrillation, and was on aspirin 100 mg and edoxaban 30 mg daily. Vital signs were stable. Examination showed left periorbital swelling and anterior thoracic bruising.

Stroke 98

Stroke Fractures Hospitals 98

Emergency Live

MAY 30, 2024

Record Heat in New Delhi At this moment, the city of New Delhi is experiencing an exceptional drought, with temperatures reaching increasingly higher records month by month. Since the beginning of May, maximum temperatures have been steadily rising at the Mungeshpur weather station, reaching 52.3 degrees Celsius. This peak has raised alarm and shown severe […] The post Extreme Heatwave in New Delhi appeared first on Emergency Live.

98

98

33 Charts

MAY 30, 2024

For most of history, medical diagnosis came through a series of chaotic steps. Patients experienced a string of studies, samples, and images coupled with a doctor’s judgment offering a best-guess answer. Or, in many cases, just a guess. Increasingly, diagnosis is being be reduced to simple transactions. Clean point-of-care testing based on molecular and marker diagnosis.

Point-of-Care Testing 97

Point-of-Care Testing Hospitals 97

St. Emlyn

MAY 30, 2024

St.Emlyn's - Emergency Medicine #FOAMed Measles is a highly contagious viral disease making a resurgence due to declining vaccination rates. It presents with initial symptoms like high fever and coryza, followed by a rash. Rapid isolation and appropriate use of PPE are critical for suspected cases. The post Measles – An Ancient Foe in Modern Times appeared first on St.Emlyn's.

PPE 102

PPE Infectious Diseases 102

PDC Healthcare

MAY 30, 2024

Efficient autoclave processes are essential for maintaining sterile environments in healthcare settings. Unfortunately, the autoclave process can often be time-consuming and resource-intensive if not managed properly. That’s why finding simple yet effective ways to streamline and enhance this process can make a significant difference in both operational efficiency and patient care quality.

Operations 91

Operations Patient Safety 91

Emergency Live

MAY 30, 2024

The Importance of Ongoing and Quality Training For first responders, advanced and continuous training is essential to maintain high skills and provide effective responses to emergencies. Through such training, they can not only update previously acquired techniques but also learn about new technologies and innovate their methods of use. Specialized Training Programs A wide range […] The post Advanced Training for Rescue Professionals appeared first on Emergency Live.

98

98

Broome Docs

MAY 31, 2024

Welcome to the June edition of the Journal Club for 2024. Justin and I discuss 7 papers covering a range of topics from securing IVCs in kids to intubating in space and the use of religious sham artifacts in middle-age, French “psychiatry” Yep, it was a strange month on the pod! Enjoy. Articles linked below and podcast available on your favourite player or YouTube over at the First10EM channel.

Airway Management 97

Airway Management Poisoning Pediatrics 97

Taming the SRU

MAY 27, 2024

Shortness of breath is one of the most common complaints presenting to emergency departments. Although the etiology is varied, in this post we will examine one specific cause – pleural effusions – in addition to management of pleural effusions with the thoracentesis procedure. Overview - what is a pleural effusion and how can i fix it? The pleural cavity is a potential space between the lung and chest wall.

Emergency Department 86

Emergency Department Ultrasounds Radiology Radiology 86

NIOSH Science Blog

MAY 29, 2024

Workplace violence impacts the mental health and wellbeing of the healthcare workforce. The negative outcomes not only affect the healthcare worker but can trickle down to patient safety and satisfaction. It is important that healthcare institutions implement workplace violence prevention programs that benefit the entire healthcare workforce. This blog post highlights current efforts across government and industry to address this critical issue.

Patient Safety 89

Patient Safety Outcomes 89

Emergency Live

MAY 30, 2024

How First Aid Training Saves Lives and Enhances Safety Training in first aid is essential to ensure the safety and well-being of individuals in emergency situations. This type of training not only equips individuals with the skills to effectively handle emergency situations but also adds confidence and tactical ability to their repertoire when they need […] The post The Importance of First Aid Training appeared first on Emergency Live.

Wellness 98

Wellness 98

EMDocs

MAY 25, 2024

Authors: Alena Hoover, MD (EM Resident Physician, ACMC/Oak Lawn, IL); Thaer Ahmad, MD (EM Attending Physician, Oak Lawn, IL) // Reviewed by: Sophia Görgens, MD (EM Physician, Northwell, NY); Cassandra Mackey, MD (Assistant Professor of Emergency Medicine, UMass Chan Medical School); Brit Long, MD (@long_brit) Welcome to EM@3AM, an emDOCs series designed to foster your working knowledge by providing an expedited review of clinical basics.

EMS 80

EMS Dehydration Operations Hospitals 80

EM Literature of Note

MAY 27, 2024

Hearkening back to my former life as the chair of an Institutional Review Board: you do not promise or imply a potential for benefit to clinical trial participants. Why? Because clinical trials aren’t designed to benefit participants. Participants may be randomized to the “standard of care” arm. The trial drug may not have any improvement in efficacy over the “standard of care” Worse, the trial drug may, in fact, have greater toxicity than the current options.

Outcomes 78

Outcomes 78

First 10 EM

MAY 31, 2024

The First10EM monthly wrap up is a place for me to share updates about the website, about my academic life, and also interesting content, such as books, podcasts, and other FOAMed, that I have encountered in the prior month. Obviously the format means the focus is mostly on content I have found, but I hope […] The post The First10EM monthly wrap-up for May 2024 appeared first on First10EM.

Academics 76

Academics 76

Emergency Live

MAY 25, 2024

How Drones Are Transforming Search and Rescue Operations The development of drone technologies has brought about a change in search and rescue operations. Devices have been equipped with advanced technologies: expanding thermal cameras with artificial intelligence. This is greatly increasing the efficiency and effectiveness of rescue missions. Today’s article shows how drones are revolutionizing the […] The post Rescue Drones: Technological Revolution appeared first on Emergency Live

Operations 98

Operations 98

EMDocs

MAY 28, 2024

Today on the emDOCs cast with Brit Long, MD ( @long_brit) , we cover part 2 of acute chest syndrome. Episode 101: Acute Chest Syndrome Part 2 Background SCD is an autosomal recessive condition that results in the formation of hemoglobin S (HbS). HbS has reduced solubility in the setting of hypoxia, leading to sickling of the RBCs. Other causes of sickling: acidosis, dehydration, inflammation, infection, fever, and blood stasis.

Blood Transfusions 75

Blood Transfusions Fluid Resuscitation Dehydration Ultrasounds 75

Emergency Medicine Cases

MAY 28, 2024

Dr. Howard Ovens reflects on the role of leader in the EM in this 2nd part of a 2-part Waiting to Be Seen blog series on EM leadership. He touches on mentoring, being committed, aligning with patients' interests, being a role model and a few quick takes on some controversial issues in EM. The post WTBS 30 Lessons on Emergency Medicine Leadership: The Role of The Leader appeared first on Emergency Medicine Cases.

Leadership 71

Leadership EMS 71

The Skeptics' Guide to EM

MAY 25, 2024

Reference: Borgundvaag et al. Guidelines for Reasonable and Appropriate Care in the Emergency Department (GRACE-4): Alcohol use disorder and cannabinoid hyperemesis syndrome management in the emergency department. AEM May 2024 Date: May 22, 2024 Dr. Bjug Borgundvaag Guest Skeptic: Dr. Bjug Borgundvaag is the Founding Director of the Schwartz/Reisman Emergency Medicine Institute (SREMI), at Sinai Health System.

Emergency Department 77

Emergency Department Best Practices Seizures Research 77

Emergency Live

MAY 25, 2024

How AI and AR Are Revolutionizing Rescue Operations Rescue operations are crucial for saving lives in emergency situations. In recent years, the advent of advanced technologies like artificial intelligence and augmented reality has significantly increased the efficiency and quality of these operations. This technological development not only speeds up response times but also improves the […] The post Innovations in Rescue: Technologies that Save Lives appeared first on Emergency Live.

Operations 98

Operations 98

Dr. Smith's ECG Blog

MAY 30, 2024

Written by Magnus Nossen, with some edits by Smith This ECG was transmitted electronically by EMS for evaluation. The patient is a 70 something female with chest discomfort and dyspnea. How would you interpret the ST changes seen in this ECG? Will you accept this patient for emergent coronary angiogram based on the ECG changes? Does the ECG represent STEMI-negative OMI findings?

EKG/ECG 71

EKG/ECG COPD EMS 71

EMCrit

MAY 25, 2024

Management of the Post-CABG pt in the ICU EMCrit Project by Katrina Augustin.

98

98

Science Based Medicine

MAY 29, 2024

Many countries (such as Kenya’s recent regulatory changes regarding Muguka use) are struggling with the dilemma of how to regulate drug use by its citizens. There are many psychoactive drugs (we seem to be good at discovering them) with a variety of effects. Often there may be subjectively desirable effects in the short term, but long term addiction, the potential for withdrawal, […] The post Khat and Muguka Use in East Africa first appeared on Science-Based Medicine.

62

62