Ken Grauer, MD

MAY 20, 2023

The ECG in Figure-1 — was obtained from an older woman with persistent CP ( C hest P ain ) over the previous day. Her symptoms lessened after Nitroglycerin — so the decision was made not to activate the cath lab. Do YOU agree with this decision? Figure-1: The initial ECG in today's case. MY Thoughts on the ECG in Figure-1: In a patient with CP that had been persistent over the previous day ( until Nitroglycerin was given ) — the initial ECG shown in Figure-1 is extremely worrisome.

EKG/ECG 363

EKG/ECG Wellness 363

RebelEM

MAY 25, 2023

I recently gave a talk on the initial management of trauma patients with hemorrhagic shock. In the initial management of trauma resuscitation there are 4 key principles that should be followed: Control bleeding Restore tissue perfusion Minimize iatrogenic injury from resuscitation itself Promote hemostasis In this blog post I will summarize the lecture and the evidence for each of these principles… MINIMIZE IATROGENIC INJURY PERMISSIVE HYPOTENSION Maintaining a lower blood pressure than physiol

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Resuscitation Fluid Resuscitation Head Injuries Shock 145

Science Based Medicine

MAY 21, 2023

British consulting cardiologist Dr. Aseem Malhotra has become the latest darling of the COVID-19 minimization and antivaccine movement in the UK. Previously known for anti-statin views and advocacy of the Pioppi diet who pivoted to more dangerous misinformation during the pandemic. The post Unsafe and Ineffective: Aseem Malhotra first appeared on Science-Based Medicine.

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The Trauma Pro

MAY 26, 2023

Here’s the final post on my series covering serial hemoglobin testing in the management of solid organ injury. We developed our first iteration of a solid organ injury practice guideline at Regions Hospital way back in 2002. It was borne out of the enormous degree of clinical variability I saw among my partners. We based it on what little was publicly available, including an EAST practice guideline.

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Blood Transfusions Operations Pediatrics Hospitals 100

Ken Grauer, MD

MAY 26, 2023

The ECG in Figure-1 was obtained from a 60-ish year old man with a history of coronary disease ( including prior CABG ) — who presented to the ED ( E mergency D epartment ) with new CP ( C hest P ain ) of 3 hours duration , diaphoresis and nausea/vomiting. The patient was hypotensive at the time his initial ECG in Figure-1 was obtained. The decision was made not to immediately perform cardiac cath — because there is no ST elevation in Figure-1 — and because the initial troponin was negative.

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EKG/ECG Wellness Resuscitation 195

Don't Forget the Bubbles

MAY 24, 2023

A 5-year-old boy with a past medical history of Crouzon syndrome presents in the Pediatric ED. He is febrile and tachypnoeic, with low blood pressure and a capillary refill time of 4 seconds. His oxygen saturations are 86% in air, and he has a GCS of 8/15. His notes suggest that he was a difficult intubation in the neonatal intensive care unit. While you prepare the difficult airway cart, a young trainee asks about cannot intubate cannot oxygenate scenarios.

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Airway Management Teamwork Pediatrics Emergency Department 98

RebelEM

MAY 24, 2023

Take Home Points The Parkland formula can be used to be a guide for initial fluid resuscitation. This is based on second- and third-degree burns (not first-degree). Utilize response to treatment as a guide to continue fluid resuscitation. Patients in fires in closed spaces for a prolonged time are at risk for airway edema and need for intubation. History of fire is very important and please monitor patient condition, patients’ voice, and repeat physical exam.

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Burns Fluid Resuscitation Resuscitation EMS 98

Thinking Critical Care

MAY 20, 2023

Super excited for this. No issues with travel this year, the H&R family all keen on getting together again, the lineup is awesome, most of the OGs able to make it, lots of new additions, and the programme is looking really sweet. Am totally amped to have Katie Wiskar as the Chair of The Hospitalist as she’s putting together a great group with sharp lectures and super interesting workshops.

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Airway Management Resuscitation EKG/ECG CPR 96

Don't Forget the Bubbles

MAY 22, 2023

You’ve just started working in the Children’s Emergency Department (CED). The triage nurse comes to let you know about Robin. He is eight years old, with a background of cerebral palsy and severe scoliosis. He has come in today because he has noisy breathing with rattly secretions that seem to be getting worse. The community physiotherapist (who has been visiting daily for the last 4 days) told Mum that Robin’s oxygen saturations were low.

Radiology 98

Radiology Radiology Hospitals Wellness 98

Medagadget

MAY 23, 2023

Researchers at the University of Göttingen in Germany have developed a cell culture chamber that lets them culture tissue samples, mimic the mechanical conditions that tissues experience in various disease states, and closely monitor tissue reactions. The technology could be particularly useful for pre-clinical drug testing, allowing researchers to test the effects of various drug candidates on tissues without the need to use experimental animals.

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Research Academics Wellness 95

ALiEM

MAY 24, 2023

A young boy is brought to the pediatric emergency screaming at the top of his lungs by his parents. His penile skin is trapped in the zipper of his jeans. On a busy shift, you want a simple way to handle zipper injuries that minimizes pain, doesn’t require resource-intensive procedural sedation, and is quick. Background The 4 most common types of zippers are nylon coil zip, plastic mold zip, metal zip, and invisible zip.

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Pediatrics 93

St. Emlyn

MAY 22, 2023

St.Emlyn's - Emergency Medicine #FOAMed On Thursday 18th May the National Institute for Health and Care Excellence (NICE) released the updated head injury guidelines: assessment and early management [NG232] There have been three head injury … NICE Head Injury Guidelines 2023: Now who do we scan? Read More » The post NICE Head Injury Guidelines 2023: Now who do we scan?

Head Injuries 93

Head Injuries 93

Dr. Smith's ECG Blog

MAY 23, 2023

Written by Pendell Meyers A man in his early 40s experienced acute onset chest pain. The chest pain started about 24 hours ago, but there was no detailed information available about whether his pain had come and gone, or what prompted him to be evaluated 24 hours after onset. EMS arrived and recorded this ECG: What do you think? See same ECG below with computer automated interpretation, using the Glasgow ECG algorithm which apparently is used by many different providers and devices Amazing that

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EKG/ECG Wellness Emergency Department EMS 93

Medagadget

MAY 26, 2023

Researchers at the Hubrecht Institute in the Netherlands have developed a biobank of cancer organoids using tissue samples obtained from head and neck cancer patients. So far, the team used the biobank to validate tumor biomarkers. Excitingly, they also correlated patient treatment responses with organoid treatment responses, suggesting that the organoids provide a good proxy for testing new treatments and for designing a personalized treatment plan for individual patients.

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Outcomes Research 93

EM Ottawa

MAY 22, 2023

Methodology: 3/5 Usefulness: 3/5 Frawley, John et al. “A Comparison of Prehospital Pediatric Analgesic Use of Ketamine and Opioids.” Prehospital emergency care, 1-5. 8 Mar. 2023, doi:10.1080/10903127.2023.2183295 Question and methods: This study sought to compare the pain reduction achieved and adverse event profile of ketamine vs opioids used for pediatric analgesia in the prehospital […] The post A Comparison of Prehospital Pediatric Analgesic Use of Ketamine and Opioids appeared first

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Pediatrics EMS 87

Science Based Medicine

MAY 22, 2023

Last week Dr. Vinay Prasad wrote a Substack arguing that medical students should learn the principles of evidence-based medicine before basic science.This is a recipe for amplifying the main flaw in EBM that science-based medicine was meant to correct, and Dr. Prasad's arguments would have been right at home on an integrative medicine blog. [Note ADDENDUM.

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Dr. Smith's ECG Blog

MAY 26, 2023

A 20-something presented after a huge verapamil overdose in cardiogenic shock. He had been seen at an outside institution and been given 6 g calcium gluconate, KCl, and a norepinephrine drip. The initial K was 3.0 mEq/L and ionized calcium was 5.5 mg/dL (sorry, Europeans, for the weird units) Here was the initial ED ECG: There is a junctional rhythm with retrograde P-waves (see the dip in the T-wave in lead II across the bottom; you can follow that up to all the other leads and see the retrograd

Shock 91

Shock EKG/ECG Documentation/Coding Resuscitation 91

PulmCCM

MAY 22, 2023

Early mobilization in the ICU has been recommended by consensus based on its strong rational basis (as a large proportion of critically ill patients develop weakness) and its apparent safety, with limited low-quality evidence supporting its benefits. In the TEAM trial conducted by the ANZICS group, 750 ICU patients in 49 hospitals in 6 countries were randomized to either early mobilization or usual care (which usually included in-bed physical therapy).

Fluid Resuscitation 86

Fluid Resuscitation Resuscitation Hospitals Sepsis 86

EM Ottawa

MAY 25, 2023

I was early in my PGY-1 year when I first witnessed an adverse effect from oral nonsteroidal anti-inflammatory drugs (NSAIDs). It was a busy morning with long patient wait times, and I picked up the chart of a 19-year-old female presenting with abdominal pain. She told me that she had severe abdominal pain overnight, and […] The post Topical NSAIDs for Acute Pain Management appeared first on EMOttawa Blog.

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Emergency Department EMS 86

Sensible Medicine

MAY 21, 2023

It’s my pleasure to introduce today’s guest post by Dave Allely. Although Mr. Allely is a medical student— his analysis of the RSV vaccine for pregnant women is superior to the FDAs. He notes a bizarre moment in the recent VRBPAC meeting where Peter Marks asked Pfizer to make a closing statement— seemingly in an effort to get the vote he wanted.

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Outcomes Hospitals Research 86

Medagadget

MAY 23, 2023

A recent study in Nature Medicine , entitled “ An automated histological classification system for precision diagnostics of kidney allografts ,” has showcased the efforts of a group of researchers who have developed an automated system that can diagnose kidney transplant rejection. A variety of disparate factors can affect the chances that a transplant will be rejected.

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Research Hospitals Documentation/Coding Operations 83

Canadian EM

MAY 23, 2023

A 3-year-old boy is brought to the ED by his anxious parents following a head injury he sustained while playing in the playground. He was running when he tripped and bumped his head against the metal steps. As you observe him calmly playing on his tablet in the waiting room, his parents are inquiring about the necessity of skull x-rays. You consider the role of such imaging in investigating pediatric head injuries –.

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Head Injuries Pediatrics 80

Dr. Smith's ECG Blog

MAY 21, 2023

An elderly patient had a fall from probable syncope, and could not get up. He complained of weakness and shortness of breath, but no CP. Vital signs were normal. Here is the first ED ECG: COMPUTER INTERPRETATION: Electronic Atrial Pacemaker. Marked ST Elevation, ACUTE MI What do you think? First, the QRS is incredibly wide! You should ask for more history.

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EKG/ECG 78

PEMBlog

MAY 26, 2023

I recorded this episode of the Cincinnati Children’s podcast Young & Healthy with Hannah Carron, one of the Pediatric Emergency Medicine at our institution. It provides succinct recommendations on when to call 911, seek care in the Emergency Department or Urgent Care, when to ask the advice of your primary care provider, and even when virtual urgent care visits are appropriate.

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Urgent Care Emergency Department Pediatrics 78

Taming the SRU

MAY 22, 2023

BACKGROUND Ankle injuries are among the most common reasons for ED visits [1]. Ankle fractures are the third most common fracture in the ED [2] and more than 20,000 patients are seen in the ED for ankle sprains each day [3]. Ankle injuries have financial implications for both the healthcare system and patients. Within the Medicare population alone, foot and ankle surgeries are responsible for more than 11 billion dollars spent annually [4].

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Fractures Dislocations Operations Radiology 77

EMDocs

MAY 26, 2023

Original podcast posted on PEM Currents – Hosted by Brad Sobolewski ( @PEMTweets ) and co-authored by Dennis Ren ( @DennisRenMD ) This podcast series by PEM Currents is a co-production with the Emergency Medical Services for Children Innovation and Improvement Center (EMSC IIC), whose mission is to minimize morbidity and mortality of acutely ill and injured children across the emergency continuum.

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Pediatrics Emergency Department Psychiatric Documentation/Coding 76

NRC Health

MAY 25, 2023

In this episode, we are joined by Mandy Riemer, Manager of Patient Experience at Children’s Mercy, and Evan Sheaff, AVP of Customer Strategy at NRC Health, to discuss how Children's Mercy is finding out what patients want most, what key trends they are seeing in patient experience, where overburdened clinicians and staff can focus on personal connections and a lot more.

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Emergency Medicine News

MAY 22, 2023

No abstract available

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EMS 75

Science Based Medicine

MAY 26, 2023

An outbreak of deadly ocular infections, which have cost some people their vision and even their life, has been traced to contaminated eye drops. The post CDC Reports Fourth Death Blamed on Contaminated Eye Drops first appeared on Science-Based Medicine.

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CDC 73

Medagadget

MAY 23, 2023

Researchers at Ecole Polytechnique Fédérale de Lausanne (EPFL) in Switzerland have developed a soft robotic electrode, that can be advanced through a small hole in the skull and then opened into a series of spiral arms, to provide electrocorticography measurements from a relatively large area of the brain surface. The technology could prove very useful for brain surgeons who wish to map regions of the brain that may be triggering epileptic seizures and then target these lesions surgically.

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Research Seizures Wellness 71

First 10 EM

MAY 22, 2023

This is a guest post by Dr. Lanujan Kaneswaran. Lanujan is a first-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. What is glomerulonephritis?

Pediatrics 65

Pediatrics 65

EMDocs

MAY 24, 2023

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.

Radiology 65

Radiology Radiology EKG/ECG Hospitals 65

Science Based Medicine

MAY 23, 2023

You can publicly disagree with a medical student who carries the imprimatur of your university and who has gained attention in the national media by spreading misinformation. The post Open Letter to a Dean: You’re Allowed to Speak first appeared on Science-Based Medicine.

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ECG Guru

MAY 24, 2023

Welcome to Dr. Andreas Roeschl, who is a cardiologist and ECG instructor in Germany. He will have a recurring blog on the Guru, contributing his knowledge about ECG and teaching, along with ECGs from his collection. His ECGs are digitized and beautiful quality for reproduction, and his contributions will be a great asset to any student or teacher of ECG.

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EKG/ECG 64

Sensible Medicine

MAY 25, 2023

On April 26, 2023, Bobby Jindal and Chirag Parghi declared, on the opinion pages of the WSJ, that “ Mammograms Can Promote Heart Health.” I’m a doctor who has referred hundreds of women for mammograms. Why didn’t I know this? Have I been neglecting the medical literature? Sensible Medicine is a reader-supported publication. To receive new posts and support our work, consider becoming a free or paid subscriber.

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Documentation/Coding Academics Wellness 61

EMDocs

MAY 25, 2023

Welcome back to the “52 in 52” series. This collection of posts features recently published must-know articles. This week we cover the ESETT trial which compares levetiracetam, fosphenytoin, and valproate for treatment of status epilepticus. Author: Christiaan van Nispen, MD (Resident, Emergency Medicine Physician, San Antonio, TX); B rannon Inman, MD (Chief Resident, Emergency Medicine Physician, San Antonio, TX) // Reviewed by: Alex Koyfman, MD (@EMHighAK); Brit Long, MD (@long_brit) Randomiz

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Seizures Administration Anaphylaxis Outcomes 64

Science Based Medicine

MAY 25, 2023

There is no evidence IV vitamin drips can help treat infertility The post No evidence IV vitamin drips can treat infertility first appeared on Science-Based Medicine.

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