Ken Grauer, MD

MARCH 15, 2024

What if you were asked to interpret the ECG in Figure-1 ? How would YOU interpret the rhythm? Even without the benefit of any history — Has there been a recent MI? Figure-1: The initial ECG in today's case. ( To improve visualization — I've digitized the original ECG using PMcardio ). MY Approach to Today’s Tracing: As always — I favor beginning assessment with a quick look at the long lead rhythm strips at the bottom of the tracing.

EKG/ECG 403

EKG/ECG Wellness 403

Pediatric EM Morsels

MARCH 15, 2024

We encounter seizures commonly in the Emergency Department. While they can be dramatic and devastating, we have learned to become comfortable with the wide variety that may present in children. From the simple febrile seizure to the complex seizure, we know how to stabilize and how to evaluate. While fortunately most seizure activity is short lived, we also know that status epilepticus can be difficult to manage, and persistent seizures should make us consider specific etiologies (ex.

Seizures 258

Seizures Pediatrics Psychiatric Emergency Department 258

The Trauma Pro

MARCH 14, 2024

Trauma professionals are never satisfied with the size of their trauma bay. Today, I’ll write about optimal trauma bay size. Next week, I’ll describe my system for quantifying the space in your trauma bay and address the equipment layout in your resuscitation room. Trauma resuscitation rooms vary tremendously. They can range from very spacious… to very tight… Most trauma bays that I have visited were somewhere between 225 and 300 square feet (21-28 sq meters), although some were quit

Resuscitation 162

Resuscitation Documentation/Coding Hospitals 162

Sensible Medicine

MARCH 13, 2024

Martin Kulldorff was a professor at Harvard Medical School who argued during the pandemic that school closure was misguided policy, lockdowns were inappropriate and draconian, vaccine mandates were unjust, natural immunity conferred protection against subsequent severe disease, kids did not need to be vaccinated, and that two year old children should not wear cloth masks in daycare.

Academics 144

Academics Hospitals 144

Ken Grauer, MD

MARCH 11, 2024

I was asked to interpret the 2-lead rhythm strip shown in Figure-1 — without the benefit of any history. What are YOUR thoughts? Is there AV block? If so — Is it complete AV block? Figure-1: You are asked to interpret this 2-lead rhythm strip without the benefit of any history. = NOTE: Today's rhythm is challenging — especially if you have not seen this type of rhythm before.

EKG/ECG 389

EKG/ECG 389

EM Ottawa

MARCH 14, 2024

Posterior circulation ischemia accounts for approximately 20-25% of all ischemic strokes and is a significant cause of patient disability. The diagnosis can be extremely challenging as findings are often not typically focal. Posterior strokes are misdiagnosed more than 3x more often than anterior circulation strokes.1 Similar to anterior circulation strokes, posterior strokes are most commonly […] The post Posterior Circulation Strokes appeared first on EMOttawa Blog.

Stroke 138

Stroke Documentation/Coding Resuscitation 138

Intensive Blog

MARCH 13, 2024

Everything ECMO 048: History of ECPR evidence and considerations for future research Author: Dr George Walker Peer reviewer: A/Prof Aidan Burrell Introduction The first recorded attempts to resuscitate patients were as early as 1530 where Swiss physician Paracelsus used fireplace bellows to reinflate the lungs of those who had stopped breathing. Several more centuries passed before techniques more akin to modern day cardio-pulmonary resuscitation were reported.

CPR 130

CPR Resuscitation Outcomes Hospitals 130

Sensible Medicine

MARCH 12, 2024

On February 8th, Lisa Rosenbaum published an excellent and thought-provoking piece in the New England Journal titled: On Being Well While Doing Well — Distinguishing Necessary from Unnecessary Discomfort in Training. This article, and the accompanying podcast , has stimulated more conversation than a “non-research” article has in years.

Wellness 120

Wellness Academics Research 120

Dr. Smith's ECG Blog

MARCH 9, 2024

Written by Willy Frick A 67 year old man with a history of hypertension presented with three days of chest pain radiating to his back. He had associated nausea, vomiting, and dyspnea. What do you think? This ECG together with these symptoms is certainly concerning for OMI, but the ECG is not fully diagnostic, and another consideration could be acute pericarditis.

EKG/ECG 118

EKG/ECG 118

ACEP Now

MARCH 11, 2024

ACEP Now wishes to congratulate the medical students who matched into emergency medicine today! This year, it is estimated that only about 137 of more than 3,000 spots remained unfilled as of Monday, March 11, 2024. This is in comparison to more than 550 unmatched positions last year. While the full explanation for the rebound in emergency medicine remains unknown, one potential reason is a large increase in international medical graduate applicants this year.

EMS 115

EMS 115

Science Based Medicine

MARCH 11, 2024

Prions. Why did it have to be prions? (Again.) The antivax trope that vaccines cause prion disease is an old one, and antivaxxers are trying desperately to resurrect it to apply to COVID-19 vaccines. The post Prions. Why did it have to be prions? (Again.) first appeared on Science-Based Medicine.

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EM Literature of Note

MARCH 12, 2024

A few words regarding an article highlighted in one of my daily e-mails – a report regarding the Elders Risk Assessment tool (ERA) from the Mayo Clinic. The key to the highlight is the assertion this score can be easily calculated and presented in-context to clinicians during primary care visits, allowing patients with higher scores to be easily identified for preventive interventions.

Outcomes 110

Outcomes Hospitals 110

Dr. Smith's ECG Blog

MARCH 14, 2024

Written by Jesse McLaren Three patients presented with acute chest pain and ECGs that were labeled by the computer as completely normal, and which was confirmed by the final cardiology interpretation (which is blinded to patient outcome) also as completely normal. What do you think? Case 1: Case 2: Case 3: Triage ECGs labeled ‘normal’ There have been a number of small studies suggesting that triage ECGs labeled ‘normal’ are unlikely to have clinical significance, and therefore that emergency phy

EKG/ECG 116

EKG/ECG Documentation/Coding Patient Safety Outcomes 116

Sensible Medicine

MARCH 11, 2024

Dear readers. the Study of the Week will need to take two weeks off. I am traveling and lecturing in Denmark. Today I post this amazing explainer on statistics. I have read a lot on the p-value and confidence interval, and this may be the best explainer I have read. It may also be the best post we have ever had on Sensible Medicine. We are grateful to the authors and to our readers.

Outcomes 108

Outcomes Research Stroke COPD 108

Taming the SRU

MARCH 11, 2024

Acute knee dislocations are rare orthopedic injuries that have high morbidity and need to be recognized quickly by the emergency physician; if unrecognized or inadequately treated, these injuries can lead to vascular and limb compromise (1,2). Knee dislocations make up less than 0.5% of all orthopedic injuries and may be difficult to recognize if the dislocation spontaneously reduces prior to care in the Emergency Department, which may occur in upwards of 50% of cases (3).

Dislocations 107

Dislocations Emergency Department Fractures Operations 107

Science Based Medicine

MARCH 13, 2024

Tik Tok is a cesspool of wellness pseudoscience and misinformation. All of social media has the potential to spread misinformation without any filter, but for some reason Tik Tok has become the preferred platform for the most outrageous claims and nonsense. A recent trend on Tik Tok (and within the wellness community generally) is the parasite cleanse.

Wellness 106

Wellness 106

Emergency Live

MARCH 13, 2024

A Future of Emergencies Managed by Artificial Intelligence The world of emergency medicine is undergoing a radical transformation thanks to the advent of autonomous ambulances. These innovative rescue vehicles, equipped with autonomous driving systems, promise to revolutionize the way emergencies are handled, improving service efficiency and patient safety.

Patient Safety 98

Patient Safety 98

Dr. Smith's ECG Blog

MARCH 13, 2024

Written by Willy Frick A man in his early 40s with BMI 36, hypertension, and a 30 pack-year smoking history presented with three days of chest pain. It started while he was at rest after finishing a workout. He described it as a mild intensity, nagging pain on the right side of his chest with nausea and dyspnea. It woke him the next day and radiated into his back.

EKG/ECG 93

EKG/ECG Urgent Care Sepsis Wellness 93

Taming the SRU

MARCH 12, 2024

Griffey RT, Schneider RM, Girardi M, et al. The SQuID protocol (subcutaneous insulin in diabetic ketoacidosis): Impacts on ED operational metrics. Acad Emerg Med 2023;30(8):800–8. 10.1111/acem.14685 Clinical Question : What is the impact of a subcutaneous insulin protocol for mild-to-moderate DKA on ED length of stay and ICU admission rates? Background Diabetic ketoacidosis (DKA) is a common and resource-intensive condition contributing to significant morbidity and mortality among patients with

Operations 96

Operations Hospitals Best Practices Wellness 96

EMCrit

MARCH 13, 2024

People on twitter absolutely hate the concept of using a central line to resuscitate a GI bleeder. This comes up a couple times per year. I think the source of this hatred is largely two-fold: A central line alone is garbage (without a Level-1 or Belmont infuser). I'll admit that. So if you're working in […] EMCrit Project by Josh Farkas.

Resuscitation 88

Resuscitation 88

Emergency Live

MARCH 13, 2024

Exploring Paths of Excellence: The Future of Nursing in Europe In a rapidly evolving healthcare landscape, specializing with a Master’s in Nursing Science can make a difference in a professional’s career. Europe offers globally recognized, high-quality programs for those ready to embark on this journey of professional growth. Leading Universities Choosing the right institution is […] The post Best Master's Degrees in Nursing in Europe appeared first on Emergency Live.

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98

American Medical Compliance

MARCH 15, 2024

Among the various areas of compliance, Fraud, Waste, and Abuse (FWA) compliance stands out as a critical pillar. The Department of Justice recently revealed charges against 78 individuals involved in healthcare fraud schemes. Therefore, for healthcare providers to prevent these charges from happening, understanding FWA compliance is essential. Healthcare organizations need to fully understand FWA compliance to maintain integrity, protect patients, and uphold regulatory standards.

Best Practices 88

Best Practices Risk Management Documentation/Coding Operations 88

Taming the SRU

MARCH 10, 2024

Qi/KT: Hypoglycemia - R1 CK: Syncope rules - R3 TTS: Traumatic cardiac tamponade - ohio aceP Guest lectUre r2 quality improvement/knowledge translation: Hypoglycemia with drs. beyde and wolski Hypoglycemia: blood glucose of <70 mg/dL. Beware of relative hypoglycemia in patients who live at very high blood glucose levels - they may have symptomatic hypoglycemia with a blood glucose that is normal for the majority of the population.

EKG/ECG 96

EKG/ECG Shock Wellness EMS 96

Sensible Medicine

MARCH 14, 2024

Continuing our commentary on Lisa Rosenbaum’s recent work, today we have the first of a two part piece by Dr. Cory Rohlfsen who has written terrific, thought provoking pieces for Sensible Medicine in the past. Adam Cifu Sensible Medicine is a reader-supported publication. If you appreciate our work, consider becoming a free or paid subscriber.

Hospitals 85

Hospitals Wellness Academics Fractures 85

Emergency Live

MARCH 14, 2024

A key development in the specialized vehicles sector In a significant move for the specialized vehicles sector, Iveco Group has announced the sale of its firefighting division, Magirus, to the German investment company Mutares. This decision marks a turning point for the company, which had already expressed its intention to divest this branch last year, […] The post Iveco sells Magirus firefighting division to Mutares appeared first on Emergency Live.

98

98

American Medical Compliance

MARCH 11, 2024

Amidst the busy dental appointments, treatments, and patient care, there are crucial aspects that often operate in the background but hold importance. These are recordkeeping and documentation. While the primary focus in dentistry is patient health and well-being, carefully keeping records is equally needed. In a survey , dental providers agree that careful and precise recordkeeping is indispensable, emphasizing the importance of documenting elements such as patient histories, examination result

Documentation/Coding 88

Documentation/Coding Best Practices Operations Outcomes 88

First 10 EM

MARCH 11, 2024

The time has come to learn from the pandemic; to learn from our mistakes (and hopefully a few successes). There are many topics to choose from. In future posts, I plan to be very positive about the tremendous work done by so many colleagues. I will probably also have to write about our incredible scientific […] The post Lessons from the pandemic: Lagging indicators appeared first on First10EM.

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86

St. Emlyn

MARCH 11, 2024

St.Emlyn's - Emergency Medicine #FOAMed Greg Yates (new to the St Emlyn's team) reviews for Journal Club a review of a JAMA paper on elderly deaths associated with long overnight waits on an ED trolley. #FOAMed @stemlyns The post JC: Are long waits in A&E lethal for elderly patients? appeared first on St.Emlyn's.

Administration 86

Administration 86

Emergency Live

MARCH 13, 2024

From Early Diagnosis to Advanced Treatments: How Science Opens New Avenues Against Ocular Melanoma Knowing the Enemy: Ocular Tumors Ocular tumors, while relatively rare, pose a significant threat to visual health. Among these, ocular melanoma emerges as the most common and dangerous, attacking the uvea, a crucial component for eye function. Unlike other tumors, ocular […] The post New Frontiers in the Fight Against Ocular Melanoma appeared first on Emergency Live.

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98

Science Based Medicine

MARCH 15, 2024

The first post-rollout data for the RSV antibody shot looks pretty good, but far too many little ones missed out. The post Some Good, But Preliminary Real World Data on Those Baby RSV Shots first appeared on Science-Based Medicine.

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84

EMDocs

MARCH 9, 2024

We always work hard, but we may not have time to read through a bunch of journals. It’s time to learn smarter. Originally published at JournalFeed , a site that provides daily or weekly literature updates. Follow Dr. Clay Smith at @spoonfedEM , and sign up for email updates here. #1: Epinephrine or Airway First in OHCA? Spoon Feed In adults presenting to EMS after OHCA, those receiving epinephrine prior to advanced airway management (AAM = supraglottic airway, SGA, or endotracheal tube) experien

Head Injuries 83

Head Injuries Airway Management Outcomes EMS 83

The Skeptics' Guide to EM

MARCH 9, 2024

Date: March 6, 2024 This is an SGEM Xtra created from a lecture I gave for the Rural Ontario Medical Program (ROMP) ICE Camp Retreat in Collingwood, Ontario last month. ROMP helps Ontario medical students & residents arrange core & elective rotations in rural Ontario. An old friend, Dr. Matt De Stefano invited me to […] The post SGEM Xtra: A Philosophy of Emergency Medicine first appeared on The Skeptics Guide to Emergency Medicine.

EMS 80

EMS 80

Emergency Live

MARCH 12, 2024

The Importance of Blood Donation and Its Health Benefits The Importance of Blood Donation Blood donation is an altruistic act that can make the difference between life and death for many people. Every day, thousands of individuals worldwide rely on blood donations to receive life-saving medical care. Blood transfusions are crucial for treating patients with […] The post Donating blood: an act of generosity that saves lives appeared first on Emergency Live.

Blood Transfusions 98

Blood Transfusions 98

EMCrit

MARCH 15, 2024

Zentensivism. EMCrit Project by Scott Weingart, MD FCCM.

71

71

Intensive Blog

MARCH 11, 2024

Everything ECMO 047: ECMO Retrieval in Victoria Author: Dr Chris Parry Peer reviewers: Dr David Anderson , Dr Andy Paton You are doing a Locum ICU shift in Mildura. It’s 23:30 on a Friday and you have just intubated a 160 kg 50yo male for respiratory failure. Despite a PEEP of 18 cmH20 and an Fi02 100% you can’t adequately oxygenate the patient. His saturations are hovering in the high 80’s.

Hospitals 69

Hospitals Radiology Radiology Sepsis 69

ALiEM

MARCH 15, 2024

A 28-year-old male presented to the ED for evaluation of an injury to his right eye. While working out with an exercise band, it snapped back, hitting the patient in the right eye. He experienced blurry vision and excess eye tearing immediately after the incident occurred. The patient also developed gross blood over the front of the eye. Physical Exam Vitals : Temp 98°F, HR 73, BP (135/77), RR 16, SpO2 99% HEENT : Gross blood in the anterior portion of the right eye (grade I).

Academics 64

Academics Administration Wellness 64

Emergency Live

MARCH 12, 2024

Addressing Preoperative Anxiety: A Clinical Imperative Approximately 70% of patients experience states of stress and anxiety before, during, and after a surgical procedure. Typically, sedatives, opioids, and anxiolytics can alleviate this discomfort, but they expose the individual to a series of significant consequences. Therefore, reducing the consumption of these drugs limits associated side effects (nausea, […] The post Hypnosis in the operating room: a new study on its effectiveness ap

Operations 98

Operations 98