Ken Grauer, MD

MAY 12, 2023

I was sent the rhythm strip shown in Figure-1 — obtained from telemetry monitoring. I did not know the history. Can YOU explain what happens after beat #4? Figure-1: Multi-lead rhythm strip obtained from telemetry monitoring. MY Thoughts on the Rhythm Strip in Figure-1: The first 4 beats in this 11-beat rhythm strip are sinus — as determined by the presence of regular upright P waves , with a constant PR interval in lead II ( RED arrows in Figure-2 ).

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The Trauma Pro

MAY 12, 2023

Any trauma professional who has dealt with spleen injuries knows that the white blood cell (WBC) count rises afterwards. And unfortunately, this elevation can be confusing if the patient is at risk for developing inflammatory or infectious processes that might be monitored using the WBC count. Is there any rhyme or reason to how high WBCs will rise after injury?

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Pediatric EM Morsels

MAY 12, 2023

We all know that Gravity Works ! While this fact can adversely affect anyone, it offers the greatest challenge for those who cannot protect themselves , like children less than 3 months of age ! We last pondered this in 2011 Morsel , just a couple years after PECARN head injury data was published. Since that time there have been several studies externally validating the PECARN rule in all age groups and in multiple different countries.

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RebelEM

MAY 11, 2023

Background: The emergency department is frequently visited by patients suffering from symptomatic alcohol withdrawal, and the traditional management has been dominated by repeated doses of benzodiazepines. 1, 2 Phenobarbital has been studied as an alternative or adjunct to benzodiazepines with encouraging results, but primarily among inpatient services. 3, 4 Much of the appeal of phenobarbital lies in its ability to stave off severe alcohol withdrawal symptoms days after administration, without

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Ken Grauer, MD

MAY 6, 2023

The ECG in Figure-1 — was obtained from an older woman with chest pain. How would YOU interpret this tracing? What kind of AV block is present? — OR — Is there no clear evidence of any AV block? 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-1: This tracing is challenging to interpret because of the changing QRS morphology — and because of the uncertainty regarding atrial activity.

EKG/ECG 195

EKG/ECG 195

The Trauma Pro

MAY 9, 2023

For years, I’ve taught my residents participating in trauma activations, “Your patient is bleeding to death until proven otherwise.” This concept served as the basis of the [poorly documented] “Golden Hour” and for decades has directed our efforts at getting patients to a center with an immediately available OR as quickly as possible.

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Don't Forget the Bubbles

MAY 10, 2023

In May 2022, Holly and Joe, two students on the joint QMUL and DFTB PEM MSc , created video presentations on human factors. We’ve incorporated some of our favourite elements from their presentations in this blog post. You’re in the paediatric emergency department, typing some notes for the child you’ve just discharged. You’re just about aware of the tannoy in the background.

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RebelEM

MAY 8, 2023

Background: Clinically significant pneumothoraces in patients on mechanical ventilation can be dangerous as positive pressure ventilation can cause an increase in intrapleural pressure and trigger tension physiology. Occult pneumothoraces are those not suspected clinically or not evident on plain radiographs but later identified on computerized tomography (CT) imaging.

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Outcomes Research Hospitals EMS 59

Mind The Bleep

MAY 12, 2023

Introduction Patients with liver disease are common in the UK. Since 1970, mortality from liver disease has quadrupled. It has become the greatest cause of death in people aged between 35-49 years old 1. It is important you know how to manage these patients in the medical take or on general medical wards and are aware of the complexities of their management.

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Science Based Medicine

MAY 12, 2023

A recent study found that young children are increasingly being harmed by accidental ingestion of cannabis in the form of edibles. The post More Marijuana More Problems for Young Children Part 2: Additional Problems for the Aforementioned Children first appeared on Science-Based Medicine.

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PHARM

MAY 12, 2023

What is prehospital care? By definition it is not hospital care. WHilst some regard the ability to deliver hospital based interventions in a prehospital setting as a form of prehospital care this will always be an approximation. Some things simply cannot be done to the same standard. Put simply its location and resources available that define prehospital care.

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Dislocations Hospitals Radiology Radiology 52

Life in the Fast Lane

MAY 11, 2023

Kyle Cunningham MD and Michael Gibbs MD Abdominal Imaging Cases 025 April 2023 Adult Abdominal imaging cases and interpretation with Kylee Brooks, Parker Hambright, Alexis Holland, William Lorenz, Brent Mathews and Kyle Cunningham

Radiology 52

Radiology Radiology 52

Mind The Bleep

MAY 12, 2023

As a foundation doctor, shortness of breath is one of the commonest symptoms you can encounter on the acute take. Causes of shortness of breath are very broad but in this session, we will discuss pleural effusion. The management will vary depending on the causes of pleural effusion, therefore the diagnostic approach is important. The first step is confirmation of pleural effusion clinically or radiologically (chest x-ray or ultrasound).

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Radiology Radiology Ultrasounds 52

NRC Health

MAY 12, 2023

Innovative approach and service-leading team set NRC Health apart in exhaustive selection process. The post UCHealth Partners with NRC Health to Improve Healthcare Experiences appeared first on NRC Health.

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SheMD

MAY 11, 2023

Here at sheMD, we believe in the importance of practicing Evidence-Based Medicine. We believe the same principles apply to discussing Gender and Medical Education. Therefore, we are bringing you an entire Journal Club series! Our series will focus on foundational and new literature within the gender and medicine space. Today, we will be discussing the article entitled, Gender-focused training improves leadership of female medical students: A randomised trial.

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PEMBlog

MAY 11, 2023

Lumbar punctures are painful! This is due to the needle puncturing the skin and deeper tissues and the pressure changes in the spinal canal. Some general recommendations to reduce pain during LP include: Comfortable Positioning: The patient should be instructed to lie on their side with their knees drawn up to their chest and their chin tucked in, or sit upright with their head and upper back forward (often on a bedside table with a pillow).

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Documentation/Coding Pediatrics Emergency Department Academics 52

EM Ottawa

MAY 11, 2023

Acute pancreatitis is one of the most common gastroenterology conditions we see in the emergency department with a prevalence of 110-140 cases per 100,000 population. (1) At The Ottawa Hospital alone, we saw over an average of 1 case per day over the last year. Unfortunately, a lot of what we do in the emergency […] The post Rethinking Acute Pancreatitis in the ED appeared first on EMOttawa Blog.

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Emergency Department Hospitals Resuscitation 52

NRC Health

MAY 11, 2023

Our partners at Phoenix Children’s share how grassroots efforts helped to define and drive patient experience priorities and build alignment throughout the organization. The post Building infrastructure to support the patient experience along the way appeared first on NRC Health.

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Science Based Medicine

MAY 10, 2023

While the COVID health emergency is over, COVID itself is not, and we need to have an eye on the next potential pandemic. The post WHO Declares COVID Emergency Over first appeared on Science-Based Medicine.

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Stop and Think

MAY 10, 2023

First read my latest on why there are so many bad medical studies. Two of the three commenters nudged me to consider a more optimistic take. One of these came from Dan Matlock, a professor of medicine at the University of Colorado. You should first know Dan is one of the smartest and kindest academics I have met. He wrote, publicly , in the comments section, that incentives to publish—even bad studies—was part of the problem, but I should consider a more optimistic take: Namely, that

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Emergency Medicine Cases

MAY 10, 2023

In this ECG Cases blog we look at 10 cases of patients with chest pain, including false positive STEMI, false negative STEMI, and other causes to help hone your ECG interpretation skills in time-sensitive cases where those very ECG skills might save a life. The post ECG Cases 42 – Approach to ECG Interpretation in Patients with Chest Pain: OMI, False Positive & Negative STEMI & Other Causes appeared first on Emergency Medicine Cases.

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EM Ottawa

MAY 10, 2023

Methodology: 2/5 Usefulness: 3/5 Market M, et al. CJEM. 2022 Jun;24(4):426-433. Question & methods: Whether quality improvement interventions could decrease the rate of repeat reductions in pediatric hand injuries by plastic surgeons. The study was conducted using two Plan-Do-Study-Act cycles that implemented informal feedback and formal educational workshops for ED physicians.

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Dr. Smith's ECG Blog

MAY 10, 2023

This was sent by a colleague. A 34 yo woman with a history of HTN, h/o SVT s/p ablation 2006, and 5 months post-partum presented with intermittent central chest pain and SOB. She had one episode of pain the previous night and two additional episodes early on morning the morning she presented. Deep breaths are painful and symptoms come and go. She had one BP that was measured at 160/120, uncertain when and what the BP was at other moments.

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EKG/ECG 52

RebelEM

MAY 10, 2023

Take Home Points Many patients with renal colic require a CT scan. Diagnostic imaging should focus on eliminating concerning mimics; not on clinching the diagnosis of renal colic. POCUS and radiology department US are important modalities in evaluation of renal colic. REBEL Core Cast 101.0 – Imaging in Renal Colic Click here for Direct Download of the Podcast References Moore CL et al.

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Radiology Radiology EMS 52

Emergency Medicine Cases

MAY 9, 2023

In this Part 1 or our two-part podcast series on STIs we discuss a general approach to cervicitis, vulvovaginitis and urethritis, elucidate some key historical features, debate who needs a pelvic exam in the ED, understand who needs what testing, debate self swabs vs physician taken swabs, dig into some specific under-recognized organisms like Mycoplasma Genitalium, figure out who needs what kind of empiric treatment, sexual partner treatment and which discharge instructions are key.

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EMS 52

Science Based Medicine

MAY 9, 2023

How would you have reacted on 1/1/2020 if a doctor claimed that a virus that killed zero children was "truly dangerous" compared to one that kill 2,000? The post An Absurd Thought Experiment first appeared on Science-Based Medicine.

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AED Leader

MAY 9, 2023

An accident on a construction site can be devastating if not deadly, so it’s important to have the right construction safety equipment on hand at all times. Some of these safety essentials are required by the Occupational Safety and Health Administration (OSHA) while others are just smart to have available. 1. Hard Hats Hard hats Read More "A Complete Construction Safety Equipment List" The post A Complete Construction Safety Equipment List appeared first on AEDs for Sale | Buy Defibrillators an

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Administration 52

EM SIM Cases

MAY 9, 2023

This case comes from Drs. Katie Maguire and Nicole Holm. Dr. Maguire is a PGY5 Emergency Medicine resident at the University of British Columbia. Her interests include medical education, disaster medicine and simulation. She is particularly interested in simulation as an educational technique to develop communication and crisis resource management skills.

Pediatrics 52

Pediatrics CPR Radiology Radiology 52

Emergency Medicine Cases

MAY 9, 2023

In this Part 1 or our two-part podcast series on STIs we discuss a general approach to cervicitis, vulvovaginitis and urethritis, elucidate some key historical features, debate who needs a pelvic exam in the ED, understand who needs what testing, debate self swabs vs physician taken swabs, dig into some specific under-recognized organisms like Mycoplasma Genitalium, figure out who needs what kind of empiric treatment, sexual partner treatment and which discharge instructions are key.

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EMS 52

NRC Health

MAY 9, 2023

NRC Health is proud to recognize and thank the incredible nurses and hospital staff who work tirelessly to keep their communities healthy and safe. Your dedication and compassion are inspiring. Thanks for all you do! The post Celebrating nurses and hospital staff appeared first on NRC Health.

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Hospitals 52

Core Ultrasound

MAY 8, 2023

At long last, Core Ultrasound Image Review episode #20! In this episode, we discuss median nerve blocks, fibroids, pneumonia, pleural effusions, CRAO, AAA, abscesses, endocarditis, DVTs, CVC confirmation and gallstones. Check out the YT for the full video! CUIR #19 CUIR #18 CUIR #17 The post Core Ultrasound Image Review, Episode 20! first appeared on Core Ultrasound.

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Ultrasounds 52

Science Based Medicine

MAY 8, 2023

Back in the day, I used to refer to something I dubbed "misinformed refusal," a term that refers to how antivaxxers had weaponized "informed consent" by inverting it to frighten parents against vaccinated. In the age of the pandemic, ProtocolKills.com generalizes misinformed refusal to all COVID-19 treatments with the help of "hospital hostage negotiator" Laura Bartlett, who views COVID-19 treatments in hospitals as "holding patients hostage" and provides an "informed consent template" that refu

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Hospitals 52

PulmCCM

MAY 8, 2023

High Impact: Rapid sequence intubation: neuromuscular blockade vs remifentanil. The ultra-short-acting opioid remifentanil could theoretically be a safer induction agent with less risk of aspiration than neuromuscular blockers like succinylcholine or rocuronium. Neuromuscular blockers relax lower esophageal sphincter tone, increasing the risk for reflux and aspiration.

Stroke 52

Stroke Hospice Blood Transfusions Anaphylaxis 52

Dr. Smith's ECG Blog

MAY 8, 2023

Sent by Pete McKenna M.D. Edits by Meyers and Smith A man in his 70s with PMH of hypertension, hyperlipidemia, type 2 diabetes, CVA, dual-chamber Medtronic pacemaker, presented to the ED for evaluation of acute chest pain. Triage ECG: What do you think? This is diagnostic of proximal LAD occlusion. This is a huge anterolateral OMI. Deadly. I cannot be anything else.

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EKG/ECG Documentation/Coding Outcomes Shock 52

Don't Forget the Bubbles

MAY 8, 2023

1-year-old Ruby presents with pallor and faltering growth. She is of Asian origin and has a family history of thalassaemia. Her blood tests show a microcytic anaemia. What do you do next? Thalassaemias are inherited blood disorders that can cause anaemia. Usually, haemoglobin, comprised of four globin chains and a haem group, carry oxygen around the body.

Blood Transfusions 52

Blood Transfusions 52

Core Ultrasound

MAY 8, 2023

At long last, Core Ultrasound Image Review episode #20! In this episode, we discuss median nerve blocks, fibroids, pneumonia, pleural effusions, CRAO, AAA, abscesses, endocarditis, DVTs, CVC confirmation and gallstones. Check out the YT for the full video!

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Ultrasounds 52

Board Bombs

MAY 7, 2023

We tell you in a few easy steps how to make your urologist love you. You shouldn't be consulting them for the vast majority of your acute urinary retention complaints. Let’s talk about presentation, causes, diagnosis, and management. Want to experience the greatest in board studying? Check out our interactive question bank podcast- the FIRST of its kind here: emrapidbombs.supercast.com.

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