Ken Grauer, MD
JUNE 26, 2023
The ECG in Figure-1 was obtained from a young man with a history of rheumatic heart disease — who presented with “palpitations”. He was hemodynamically stable at the time this tracing was recorded. How would YOU interpret the ECG in Figure-1 ? How would you treat the patient? Figure-1: The initial ECG in today’s case. What is the rhythm? How would you treat the patient?
Pediatric EM Morsels
JUNE 30, 2023
I’m sure you can recall at least several parents who bring their children into the ED for concern of recurrent pneumonias. Often the parents focus on a possible underlying immunodeficiency. Fortunately, most commonly these pneumonias are due to viral infections, and we can often offer reassurances to the parent. The differential could also include aspiration , asthma , and bronchiectasis depending on the patient’s history.
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The Trauma Pro
JUNE 27, 2023
It’s been five years since I published my series on the use of the electronic trauma flow sheet (eTFS). Anyone who knows me is familiar with my skepticism about this tool. I’ve been writing about the significant problems it can create since 2008! With the progress in computing power and interfaces we have enjoyed, we would have this problem solved by now.
Don't Forget the Bubbles
JUNE 30, 2023
A PEM adventure It’s time for another PEM adventure. Join us on another journey (with an inbuilt time travel machine) in managing Elsa, a 2-year-old girl who is a HUGE fan of the Disney movie, Frozen. Elsa was found face down in the family pool 20 minutes after last visual contact and was picked up without resuscitation. Emergency Medical Services found her apneic and pulseless.
RebelEM
JUNE 29, 2023
Back on June 1 st , 2023, Swami wrote a blog post on REBEL EM titled, The CT FIRST Trial, Should We Pan-CT After ROSC? This stemmed a lot of discussion in the background between Swami, myself, and Scott. We felt it was worthwhile to record this as a podcast to better flush out some nuanced points. Below you will find some of the points we discussed.
Emergency Live
JUNE 28, 2023
An early prototype defibrillator was built by the American surgeon Claude S. Beck at the University of Cleveland in 1974; it saved the life of a 14-year-old boy who suffered ventricular fibrillation during surgery The post Defibrillator, a bit of history appeared first on Emergency Live.
The Trauma Pro
JUNE 30, 2023
Today, I’ll kick off my series on the use of the electronic trauma flow sheet (eTFS). The biggest question is, why does your hospital want you to use it? Typically, hospital administrators pressure trauma programs to adopt an eTFS at some point after implementing the hospital-wide use of an electronic health record (EHR). When I started this series nearly 15 years ago, many hospitals still used paper charting.
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RebelEM
JUNE 26, 2023
Background: Hemorrhage is the leading cause of mortality in trauma patients. Interventions such as early application of hemorrhage control, tranexamic acid, reduction of crystalloid fluid administration and balanced ratio blood product transfusion have improved many patients’ outcomes. However, mortality still remains high due to trauma-induced coagulopathy.
Greater Sydney Area HEMS
JUNE 25, 2023
In this episode, Senior Staff Specialist Dr Geoff Healy reflects on a formative case with unexpected long term follow-up, and how this has shaped his clinical career as both a physician, and mentor.
Emergency Live
JUNE 30, 2023
Meningitis is an infection of the meninges, the protective membranes surrounding the brain and spinal cord. It can affect anyone, but is most common in infants, young children, adolescents and young adults The post Meningitis: symptoms, causes, diagnosis and treatment appeared first on Emergency Live.
Don't Forget the Bubbles
JUNE 30, 2023
A PEM Adventure Ranulf is a 14-year-old explorer. He has already climbed Ben Nevis in Scotland, visited the Gobi desert (possibly from the comfort of his parents 4 x 4, but who’s judging) and has his bronze D of E nailed. Whilst you were busy managing head injuries and drownings, Ranulf had been out with a group of boys from school this evening. They had been enjoying a celebratory dinner following their safe return from a trip to the Amazon rainforest.
First 10 EM
JUNE 26, 2023
I think the conclusions of the paper are incredibly obvious, and therefore not practice changing, but I worry that a superficial read might lead to misinterpretation, and therefore the paper is probably worth covering. (This is the same research group that published the infamous PESIT study, and all the subsequent misinformation about PE risk in […] The post PE risk in severe exertional dyspnea appeared first on First10EM.
Science Based Medicine
JUNE 24, 2023
The amount of energy needed to refute b t is an order of magnitude bigger than that needed to produce it. The post Steve Kirsch and Brandolini’s law first appeared on Science-Based Medicine.
Emergency Live
JUNE 28, 2023
Even the trachea, like other organs, can become inflamed due to viruses and bacteria. In this case we speak of "tracheitis" The post Tracheitis: symptoms, causes, diagnosis and treatment appeared first on Emergency Live.
Don't Forget the Bubbles
JUNE 26, 2023
In this case-based article, we’ll talk about single ventricle defects and their management (both medical and surgical), then look at the two main shunt options during Stage 1 reconstruction. Single ventricle defects Many complex congenital heart defects have single ventricle physiology. This means that one ventricle is too small, weak or obstructed to pump effectively, leaving the other ventricle to supply both systemic and pulmonary circulations in parallel via a shunt such as the ductus
St. Emlyn
JUNE 28, 2023
St.Emlyn's - Emergency Medicine #FOAMed We love a jolly @StEmlyns and true to form we were off to the UK Intensive Care Society State of the Art conference this week in Birmingham. This is always … ICS #SOA23 – Day 1 Read More » The post ICS #SOA23 – Day 1 appeared first on St.Emlyn's.
NRC Health
JUNE 30, 2023
In this episode Amy Feeder, Customer Experience Program Manager at M Health Fairview and Jon Tanner, Program Director of Human Understanding at NRC Health join us to discuss the importance of team recognition and how it strengthens patient care. The post Attracting and Retaining Talent using Team Recognition appeared first on NRC Health.
Emergency Live
JUNE 30, 2023
The defibrillator is a device capable of generating a controlled electrical discharge to the heart in order to re-establish the rhythm of its beats in the event of cardiac arrest or rhythm alterations The post Cardiac arrest, let's talk about defibrillator voltage appeared first on Emergency Live.
EM Ottawa
JUNE 29, 2023
Patients with heart failure are often newly diagnosed in the Emergency Department, or are the presenting location for those with decompensated heart failure. This is why it is important for ER Physicians to remain updated on the latest AHA/ACC/HFSA guidelines for the management of heart failure. In this post, we are going to touch on: […] The post Don’t go Breaking my Heart: 2022 Heart Failure Guidelines appeared first on EMOttawa Blog.
St. Emlyn
JUNE 29, 2023
St.Emlyn's - Emergency Medicine #FOAMed We’re back for the second day of the Intensive Care Society Sate of the Art Congress here in Birmingham! Yesterday was great and we learnt a lot with loads of … ICS #SOA23 – Day 2 Read More » The post ICS #SOA23 – Day 2 appeared first on St.Emlyn's.
PEMBlog
JUNE 27, 2023
It is summertime, so the bees and bugs are out! In this episode, Dr. Ben Grebber, a pediatric resident at Boston Children’s Hospital/Tufts Children’s Hospital, discusses Bee Stings and Spider Bites. A very common pediatric summer complaint in emergency departments, urgent cares, and primary care offices, this episode covers common signs and symptoms, some pathophysiology, and recommended treatments.
Emergency Live
JUNE 29, 2023
BLSD stands for Basic Life Support Defibrillator, i.e. first aid manoeuvres using a defibrillator The post BLSD: what is it? How should the manoeuvres be performed? appeared first on Emergency Live.
Science Based Medicine
JUNE 25, 2023
Joe Rogan conveyed a challenge by antivax crank turned Presidential candidate RFK Jr. to vaccine scientist Dr. Peter Hotez to "debate me, bro!" In the week since, wealthy right wingers have added money to the inducement, and through an awful op-ed by Ross Douthat this weekend, even the New York Times has amped up the pressure for a "debate" about vaccines with RFK Jr.
Intensive Blog
JUNE 26, 2023
Author: Dr Ken Hoffman Peer reviewer: A/Prof Chris Nickson These videos are aimed at ICU staff and trainees who are new to ECMO. Part 1 focusses on nomenclature and components of ECMO (extracorporeal membrane oxygenation). Part 2 focusses on V-V (veno-venous) ECMO. Part 3 tackles V-A (veno-arterial) ECMO and the final video, Part 4, addresses ECPR (ECMO-CPR during cardiac arrest).
PulmCCM
JUNE 26, 2023
An expert panel broadened the definition of acute respiratory distress syndrome (ARDS). They announced this at the American Thoracic Society meeting in May 2023. Thirty-two experts virtually to update the 2012 update (in Berlin) , and declared that ARDS shall henceforth include anyone with: PaO2/FiO2 ≤300 mmHg (on an arterial blood gas) or SpO2/FiO2 ≤315mmHg with SpO2 ≤97% (on pulse oximetry without an ABG) That’s while receiving either mechanical ventilation, or (this is
Emergency Live
JUNE 30, 2023
Congenital heart disease: with the term congenital, we indicate something already existing at birth By congenital heart disease, we are therefore referring to an alteration in cardiac structure or function that is present at birth and manifests its first symptoms early on, at conception and in the embryo-fetal phase. However, it can also be discovered […] The post What are congenital heart diseases appeared first on Emergency Live.
SCGH ED
JUNE 29, 2023
The Neurology Rapid Access Clinic (NRAC) will commence 3/7/23. This clinic has opened with the intent of diverting patient’s with symptoms consistent with a diagnosis of a Transient Ischaemic Attack from hospital admission for investigation and having them worked up in an expedited fashion as an outpatient. ED will now be able to clinically assess patients, organise appropriate initial investigations (including a CT/CTA) and then discharge them to be seen in the clinic, ideally within less
Dr. Smith's ECG Blog
JUNE 28, 2023
EMS was dispatched for a 30-something male who feels his heart is racing. Sudden onset. The patient had no previous medical history. Vitals were normal except for a heart rate of 226. A prehospital 12-lead was recorded: There is a regular wide complex tachycardia. The computer diagnosed this as Ventricular Tachycardia. Is it definitely VT?? The patient was given 6mg, then 12 mg, of adenosine, without a change in the rhythm.
St. Emlyn
JUNE 25, 2023
St.Emlyn's - Emergency Medicine #FOAMed Critical appraisal of the DEVICE trial as published in 2023 NEJM. VL outperforms DL in this study of critically unwell patients. #FOAMed #airway @stemlyns The post JC – Video vs Direct Laryngoscopy for Tracheal Intubation of Critically Ill Adults appeared first on St.Emlyn's.
Emergency Live
JUNE 28, 2023
Globally, 12 out of 1000 subjects suffer from Ménière's syndrome: it is a disorder that affects the inner ear, causing dizziness, tinnitus, hypoacusia, loss of balance, feeling of full ear and, very frequently, even nausea and vomiting The post Ménière’s syndrome: what it is, symptoms, causes and treatment appeared first on Emergency Live.
Science Based Medicine
JUNE 30, 2023
Those of us who thought about vaccines before the pandemic know perfectly well that anti-vaxxers start with their conclusions and work backwards to retrofit the "evidence." Doctors who do the same shouldn't be regarded any differently. The post Kids Don’t Need the Vaccine Because They Are Less Likely to Acquire SARS-CoV-2 and Because Most Already Had COVID-19 first appeared on Science-Based Medicine.
Medagadget
JUNE 28, 2023
Researchers at the University of Connecticut have developed an ultrasound implant that can assist in opening the blood brain barrier to allow chemotherapy to enter and treat brain cancer. However, unlike cumbersome ultrasound systems, this technology can be implanted directly into the brain, and does not require a follow-up surgery to remove the device later as it degrades away to nothing in the brain over time.
Sensible Medicine
JUNE 30, 2023
KW was a 58-year-old man with long standing type 1 diabetes mellitus and hypertension. He came to an appointment one Friday afternoon with chest pain. The pain had been present intermittently for 10 days. It was on the left side of his chest and beneath his sternum. It did not radiate anywhere, it was not related to exertion, nor was it associated with diaphoresis or shortness of breath.
Emergency Live
JUNE 29, 2023
Borderline personality disorder is a highly controversial diagnostic entity. Sometimes it is not even recognised as a specific disorder The post Borderline personality disorder: definition, causes, symptoms, diagnosis and treatment appeared first on Emergency Live.
Dr. Smith's ECG Blog
JUNE 26, 2023
== MY Comment , by K EN G RAUER, MD ( 6/26 /2023 ): == The tracing in Figure-1 was sent to me — without the benefit of any history. How would YOU interpret this tracing? Figure-1: The initial ECG in today's case. ( To improve visualization — I've digitized the original ECG using PMcardio ). MY Initial Thoughts: My attention was immediately drawn to the long lead rhythm strip in Figure-1.
Medagadget
JUNE 26, 2023
BBy , a medtech company based in New York, has developed a spray drying method that hospitals can use to process human breast milk into a shelf-stable powder. Human breast milk is an incredibly important source of nutrition for neonates in intensive care units (NICUs). At present, human donor milk is frozen and must be defrosted prior to use in such facilities.
Sensible Medicine
JUNE 26, 2023
Dr. Mandrola and I are trading beats this week. I am posting the “Study of the Week” today and John will be publishing a “My Favorite Article” piece later in the week. Over time, I have realized the type of medicine I enjoy practicing. I love evaluating symptoms, making diagnoses, and curing (or more commonly managing) diseases.
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