Ken Grauer, MD

JUNE 14, 2024

The ECG in Figure-1 — was obtained from a middle-aged man who presented to the ED ( E mergency D epartment ) in cardiac arrest. ROSC ( R eturn O f S pontaneous C irculation ) was obtained — and ECG #1 was recorded. In view of this history — How would YOU interpret the ECG in Figure-1 ? Should you activate the cath lab? Figure-1: The initial ECG in today's case. ( To improve visualization — I've digitized the original ECG using PMcardio ).

EKG/ECG 407

EKG/ECG Wellness Hospitals 407

The Trauma Pro

JUNE 14, 2024

A bucket-handle injury is a relatively uncommon complication of blunt trauma to the abdomen. It only occurs in a few percent of patients, but is much more likely if they have a seat belt sign. The basic pathology is that the bowel mesentery (small bowel of sigmoid colon) gets pulled away from the intestinal wall. This injury is problematic because it may take a few days for the bowel itself to die and perforate.

Operations 147

Operations Radiology Radiology Hospitals 147

Pediatric EM Morsels

JUNE 14, 2024

Ooooo the infamous chief complaint of “ weakness ” ……. We just love those don’t we? Although neurological complaints may not be a crowd’s favorite, it is one we must become comfortable with. Timely recognition and treatment can be life-improving and life-saving! So, with that goal in mind, let us digest another delicious morsel on weakness – Acute Transverse Myelitis in Children : Acute Transverse Myelitis in Children: Basics Rare, non-compressive, inflammatory condition of the spinal cord

Pediatrics 141

Pediatrics EMS Outcomes 141

First 10 EM

JUNE 13, 2024

Preparation for intubation, appropriate preoxygenation, and preventing peri-intubation arrests has been one of my core topics for conference talks. My initial airway series emphasized “optimizing the basics” and carefully considering “is this patient ready for intubation?”. My “RSI and then they die” lecture is by far my most watched video on YouTube.

EMS 131

EMS 131

Science Based Medicine

JUNE 9, 2024

If were are supposed to be indifferent to the deaths of young people because "hardly any" died, and we are supposed to be indifferent to the deaths of older people because "their time to death in general is not that long," which of the 1.1 million COVID deaths should we care about? The post “This Thing Has Killed Less Than Or About As Many As Flu Would Kill In A Normal Year In Kids, I Say Hardly Any” & “80-Year-Olds, Their Time To Death In General Is Not That Long.” first appeared on Science

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ALiEM

JUNE 10, 2024

For years, adult literature has provided clear guidelines for cervical spine imaging through the NEXUS and Canadian C-spine Rule (CCR) tools. These have been invaluable in helping clinicians decide when to image the neck in trauma patients. Similarly, the Pediatric Emergency Care Applied Research Network (PECARN) has developed robust tools for assessing blunt head trauma in children.

Pediatrics 126

Pediatrics Emergency Department Research Fractures 126

EMCrit

JUNE 13, 2024

the PREOXI trial validates what I have been saying for 15 years about preoxygenation for the critically ill patient EMCrit Project by Scott Weingart, MD FCCM.

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130

Science Based Medicine

JUNE 13, 2024

Although multiple antivaccine investigations have failed to deliver any substantive evidence of alleged crimes, the latest antivax flops won't flip anyone. The post “Fauci Files” and Florida’s Grand Jury Investigations Fail to Deliver first appeared on Science-Based Medicine.

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120

Sensible Medicine

JUNE 9, 2024

Recently I heard the story about a residency program where it is a cultural norm to call out “fake sick.” In other words, if a resident has a particularly long or rough day, if they feel they need some rest— even in the absence of fever, chills, drenching night-sweats and propulsive vomiting— they will call out “sick” Covering residents remark how interesting it is that fake sick days are usually on weekends or adjacent to weekends (Mon-Fri), and that this is

Wellness 123

Wellness 123

Dr. Smith's ECG Blog

JUNE 11, 2024

Written by Pendell Meyers with edits by Smith. Sent by anonymous A man in his 40s with no previous heart disease presented within 30 minutes of onset of acute chest pain that started while exercising. There was associated shortness of breath and left arm radiation. This Triage ECG (ECG #1) was recorded on a chest pain patient at triage at 1906 (top highest quality image, bottom photo including computer algorithm interpretation): "Sinus rhythm, normal ECG" (This was performed on a Mortara machine

EKG/ECG 111

EKG/ECG Documentation/Coding Emergency Department Wellness 111

St. Emlyn

JUNE 11, 2024

St.Emlyn's - Emergency Medicine #FOAMed Discover the highlights of Day 1 at the Premier conference on Paediatric Emergency Medicine. The post Paediatric Emergency Medicine – Premier Conference – Day 1 appeared first on St.Emlyn's.

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110

Science Based Medicine

JUNE 12, 2024

What are “ultraprocessed foods” and are they a health risk? One would think there is reason for concern, given all the hyped headlines, but as is often the case the data is somewhat complicated. The complexity begins with the fact that there is no agreed-upon operational definition of “ultraprocessed food” (UPF). Processed food generally refers to food products that are already prepared […] The post Ultraprocessed Foods first appeared on Science-Based Medicine.

Operations 98

Operations 98

Sensible Medicine

JUNE 10, 2024

This is a story about placebo effects. I raise the issue because the prominent journal JAMA-Psychiatry published a paper purporting to show that placebos have great effects in many psychiatric conditions. The erroneous conclusion provides excellent teaching points. First a Thought Experiment Say I gave 100 cyclists a red supplement designed to increase muscle contraction and increase pedal power.

Psychiatric 109

Psychiatric Research 109

Emergency Live

JUNE 13, 2024

Origins of the 911 Number The emergency number 911, known in the United States as the universal number for emergencies, has its origins in the 1960s. Before 911, there wasn’t a single number that anyone in distress could call, which led people to often dial direct numbers of local police stations, fire departments, or hospitals, […] The post The History of the 911 Emergency Number appeared first on Emergency Live.

Hospitals 98

Hospitals 98

St. Emlyn

JUNE 14, 2024

St.Emlyn's - Emergency Medicine #FOAMed This secondary analysis of the DOSE VF trial highlights double sequential external defibrillation (DSED) as a superior strategy over standard and vector change defibrillation for refractory ventricular fibrillation (RVF) in out-of-hospital cardiac arrest, improving survival rates and neurological outcomes significantly.

Outcomes 109

Outcomes Hospitals Resuscitation 109

Dr. Smith's ECG Blog

JUNE 9, 2024

A patient presented with hypotension and altered mental status and presumption of DKA. As the medics arrived, they handed me this ECG: What medication did I call for IMMEDIATELY when I saw this? This is obviously severe hyperkalemia and the patient is near cardiac arrest. The medics had no idea. I called for 2 grams of Calcium Chloride. There was no IV access, so we obtained intraosseous (IO) access, but she arrested before we could give her all the calcium.

EKG/ECG 130

EKG/ECG Resuscitation Shock Wellness 130

Sensible Medicine

JUNE 8, 2024

Recently, Aaron Goodman, a hematologist at UCSD, tweeted: It generated a backlash, particularly among doctors who run research labs, some e.g.s The dialog raises several adjacent questions Are physician scientists — people who mostly run labs and see patients 1/2 a day a week in clinic and 2-4 weeks a year in the hospital — good doctors ?

Research 104

Research Outcomes Hospitals Wellness 104

Emergency Live

JUNE 12, 2024

An Intricate World of Adenomatous Polyps Adenomatosis occurs when numerous adenomatous polyps form within the body. Adenomatous polyps are benign glandular tumors. They can arise in various organs, but are most common in the colon. These polyps vary greatly in shape and size and, although benign in the early stages, can become neoplastic cells if […] The post Adenomatosis: Understanding a Complex Condition appeared first on Emergency Live.

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First 10 EM

JUNE 10, 2024

As we have covered multiple times before, the evidence for paxlovid is heavily conflicted and mostly negative. There is very little reason to be using this agent clinically. However, despite an utter lack of evidence, many people have held out hope that paxlovid might be the miracle cure for the nebulous long COVID syndrome (referred […] The post Paxlovid doesn’t work for long COVID either (The STOP-PASC trial) appeared first on First10EM.

EMS 96

EMS 96

Taming the SRU

JUNE 12, 2024

Perelman VS, Francis GJ, Rutledge T, Foote J, Martino F, Dranitsaris G. Sterile versus nonsterile gloves for repair of uncomplicated lacerations in the emergency department A randomized controlled trial. Ann Emerg Med 2004;43(3):362–70. 10.1016/j.annemergmed.2003.09.008 This was a multicenter, prospective, and single blinded randomized control trial designed to determine whether rates of infection after repair of uncomplicated lacerations in immunocompetent patients is comparable using clean non

Emergency Department 93

Emergency Department Hospitals Wellness 93

Science Based Medicine

JUNE 14, 2024

A doctor who actually treated COVID patients said at the start of the pandemic, "Just because they are young doesn’t mean they aren’t vulnerable." The post Dr. Jay Bhattacharya: “An Infection Is A Severe Problem For Older Populations, and Also For People Who Have Certain Chronic Conditions. For Younger Populations Under 70, It’s Much Milder.” first appeared on Science-Based Medicine.

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Emergency Live

JUNE 11, 2024

Advanced Training for Security and Civil Protection Professionals: Registrations Open Until November 8, 2024 The Università Cattolica del Sacro Cuore is launching a new Master’s program in Crisis & Disaster Management, led by Professor Marco Lombardi. This interdisciplinary program aims to provide qualifications and professional recognition in the field of Civil Protection, healthcare, and specific […] The post Master in Crisis & Disaster Management: Enrolment open appeared

Disaster Management 98

Disaster Management 98

EMDocs

JUNE 12, 2024

Today on the emDOCs cast with Brit Long, MD ( @long_brit) , we look at hypocalcemia in trauma and the diamond of death. Episode 102: Hypocalcemia in Trauma and the Diamond of Death Why is hypocalcemia in trauma something we should know about? Previous triad of death = hypothermia, acidosis, and coagulopathy. All are associated with critical illness and severe hemorrhage.

Hyperthermia / Hypothermia 89

Hyperthermia / Hypothermia Resuscitation Administration Blood Transfusions 89

Dr. Smith's ECG Blog

JUNE 13, 2024

This case was posted by Eric Funk ( [link] ) , editor of the Expert Witness Newsletter , on his site. Here is the case on his site. He has graciously allowed me to repost it here. It is a case he presented several years ago, but then want to re-visit in light of the Queen of Hearts AI system. Don't miss his analysis and assessment of the Queen of Hearts AI OMI ECG bot -- that assessment is at the very bottom of the post.

EKG/ECG 89

EKG/ECG Documentation/Coding EMS Burns 89

EB Medicine

JUNE 12, 2024

In this episode, Sam Ashoo, MD and T.R. Eckler, MD interview Corey Hazekamp, MD, MS, one of authors of the June 2024 Emergency Medicine Practice article, Managing Emergency Department Patients With Opioid Use Disorder Current State of Opioid Epidemic Overview of overdose deaths and trends. Data and statistics about opioid overdose mortality rates.

Emergency Department 82

Emergency Department Administration EMS Research 82

Emergency Live

JUNE 11, 2024

At the center of attention will be climate change, civil protection, artificial intelligence, and sustainability. We are halfway through the journey leading up to INTERSCHUTZ, scheduled in Hannover from June 1st to June 6th, 2026. The next edition of the world’s leading trade fair for fire and rescue services, civil protection, and security is exactly […] The post Four focal themes for Interschutz appeared first on Emergency Live.

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98

Science Based Medicine

JUNE 10, 2024

The Washington Post recently published an article asking if COVID-19 infection can cause cancer. Probably not, but cancer caused by a virus is more more plausible than "turbo cancer" caused by the vaccine. The post Forget “turbo cancers” caused by COVID-19 vaccines. Does COVID itself cause cancer? first appeared on Science-Based Medicine.

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EMDocs

JUNE 8, 2024

Authors: Eliza Szybka, DO (EM Resident Physician, Department of Emergency Medicine, Advocate Christ Medical Center, Oak Lawn IL); Michael Cirone, MD (@mcironeMD, Assistant Program Director, Advocate Christ Medical Center, 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

EMS 81

EMS Allergic Reactions Poisoning Emergency Department 81

MDisrupt

JUNE 12, 2024

In the rapidly evolving landscape of healthcare technology, the integration of clinicians into product development teams has emerged as a crucial element for success. As a panelist on "Clinicians who VC," I had the opportunity to discuss the multifaceted roles clinicians play in product development and the unique value they bring to the table.

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78

Emergency Live

JUNE 10, 2024

The complexity of rescue operations Rescue operations following mining accidents represent some of the most dangerous and complex rescue challenges. Coordination, advanced technologies, and specialized skills are essential to overcome obstacles such as collapses, floods, and critical weather conditions. Preparation and initial response Preparation is key in this process.

Operations 98

Operations 98

Science Based Medicine

JUNE 9, 2024

Last week, the New York Times ran an op-ed by Alina Chan, Queen of lab leak conspiracy theories and then gave it a prominent place in its Sunday Magazine this weekend. How is it wrong? Let me count the ways. The post The New York Times promotes “lab leak” conspiracy theories first appeared on Science-Based Medicine.

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EMDocs

JUNE 13, 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.

Documentation/Coding 77

Documentation/Coding Patient Safety Emergency Department Hospitals 77

Dr. Smith's ECG Blog

JUNE 14, 2024

Written by Willy Frick A 57 year old man with was admitted to the hospital with chest pain. He underwent coronary angiography which showed severe multivessel disease, and he agreed to proceed with workup for CABG. Overnight, his cardiac telemetry showed the following: Telemetry Sample 1 What do you think? The rhythm terminated before it could be captured on 12-lead.

EKG/ECG 77

EKG/ECG Wellness Hospitals 77

Emergency Live

JUNE 8, 2024

Preparing for Emergencies During Vacation When planning a vacation, it’s crucial to pack a well-stocked emergency kit. This kit can make the difference between a peaceful vacation and a stressful situation in case of minor accidents or health issues. Here’s a comprehensive guide on what to include to be prepared for any situation. Essential Medications […] The post Suitcase for emergencies: what to take on vacation appeared first on Emergency Live.

Wellness 97

Wellness 97

Sensible Medicine

JUNE 11, 2024

In today's rapidly evolving technological landscape, innovation is challenging human adaptability such that we are barely able to predict which technology will exist within the next six months. One of the most striking examples of this acceleration is the release of Large Language Models (LLMs). In November 2022, OpenAI launched ChatGPT-3.5. Over the following 18 months, not only were two upgrades released for ChatGPT but users also got the ability to create their own GPTs through more specific

Documentation/Coding 74

Documentation/Coding Wellness Outcomes Research 74

Life in the Fast Lane

JUNE 12, 2024

Kane Guthrie Nebulised GTN in the ED Nebulised GTN in the ED.

Administration 104

Administration 104

EM Ottawa

JUNE 10, 2024

Methodology: 3.5/5 Usefulness: 2.5/5 Montini G, et al. Pediatrics. 2024 Jan 1;153(1):e2023062598. Question and Methods: This multicenter, parallel-group randomized controlled trial intended to determine the non-inferiority of a 5-day versus 10-day course of oral clavulin for treating of febrile urinary tract infections (fUTI) in children. Findings: The primary outcome of recurrence of UTI within 30 […] The post Short Oral Antibiotic Therapy for Pediatric Febrile Urinary Tract Infections:

Pediatrics 60

Pediatrics Outcomes Infectious Diseases 60