The Skeptics' Guide to EM

SEPTEMBER 21, 2024

Naloxone and Patient Outcomes in Out-of-Hospital Cardiac Arrests in California. Your partner asks if you want to administer naloxone as well. Background: We’ve discussed out-of-hospital cardiac arrest (OHCA) at least once or twice on the SGEM (see long list at end of blog). Date: September 18, 2024 Reference: Dillon et al.

Hospitals 104

Hospitals CPR EMS Outcomes 104

The Trauma Pro

JULY 9, 2024

Patients with cervical fractures more commonly need a tracheostomy for ventilatory support and/or have a head injury , and these are well known culprits in dysphagia Normal soft tissue (<6mm at C2, <22mm at C6) A study in the Jan 2011 Journal of Trauma outlined the dysphagia problem seen with placement of a halo vest.

Head Injuries 264

Head Injuries Fractures Hospitals Wellness 264

Pediatric EM Morsels

JULY 19, 2024

DON’T forget to put on your Personal Protective Equipment as well! If bleeding has completely stopped, most of these children still come into the hospital for observation so access will likely be necessary and helpful should patient have rebleed event. Have traditional, direct laryngoscopes available as well.

Airway Management 290

Airway Management Pediatrics Wellness Operations 290

Ken Grauer, MD

JUNE 22, 2024

See ECG Blog #313 — as well as My Comment at the bottom of the page in the June 17, 2024 post in Dr. Smith's ECG Blog ). During my decades of working with residents when hospital Attending — by far, the most commonly overlooked vital sign was respiratory rate. PEARL # 2: Acute PE remains one of the most commonly overlooked diagnoses.

EKG/ECG 433

EKG/ECG Stroke Documentation/Coding Wellness 433

Ken Grauer, MD

DECEMBER 29, 2023

The "good news" — is that after an extended hospitalization, the patient was finally discharged home, and doing well. = . = The H ISTORY in T oday's C ASE: The patient in today's case is a teenager who presented to the ED ( E mergency D epartment ) in cardiac arrest after electrocution.

EKG/ECG 430

EKG/ECG Resuscitation Hospitals Wellness 430

The Trauma Pro

SEPTEMBER 17, 2024

Much depends on local policies and procedures, training, as well as availability. And they are better versed in performing amputations that involve the upper extremity, as well as more proximal amputations (shoulder, upper thigh). Getting them to the scene will always take extra time since they are typically hospital-based.

Airway Management 199

Airway Management Operations Hospitals Wellness 199

The Trauma Pro

JUNE 21, 2024

The VIP syndrome occurs in healthcare when a celebrity or other well-connected “important” person receives a level of care that the average person does not. References: “ The VIP Syndrome”: A Clinical Study in Hospital Psychiatry. Who is a VIP? It may be a celebrity. A family member. Or even a colleague. Cleve Clin J Med.

Documentation/Coding 290

Documentation/Coding Outcomes Hospitals Wellness 290

EMDocs

DECEMBER 11, 2024

Facts : A 28-year-old female is seen in the ED of Hospital A for recurrent bouts of severe, intermittent abdominal pain. 5 days later she is seen at Hospital B for similar symptoms. Another 10 days later she is seen at Hospital C , treated a third time for low sodium and discharged, this time with hydromorphone.

Hospitals 97

Hospitals Patient Safety EMS Wellness 97

The Trauma Pro

JUNE 30, 2023

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.

Hospitals 100

Hospitals Administration Resuscitation Best Practices 100

The Trauma Pro

NOVEMBER 17, 2023

Well, it’s not supposed to be that way. The whole point of adhering to the usual ATLS protocol is to ensure that the patient stays alive through and well after your exam. My previous statements were based on the way that we organize our trauma team and trauma activations at this hospital. In principle, I agree.

Resuscitation 214

Resuscitation Ultrasounds Hospitals Wellness 214

Ken Grauer, MD

JUNE 14, 2024

The above said, when for whatever reason sinus P waves are not well seen in lead II — the 2nd -best lead when looking to determine if sinus rhythm is present, is lead V1. Retrospective questioning of the driver who brought this patient to the hospital revealed that he was having chest pain as the reason for presenting to the ED.

EKG/ECG 389

EKG/ECG Wellness Hospitals 389

The Trauma Pro

SEPTEMBER 20, 2024

Getting there includes an obvious problem: what happens when the physician leaves the hospital? Other surgeons may be available in the hospital during the daytime, although they may have other responsibilities keeping them busy. This is important for the well-being of the patient, the rescue crews, and the patient.

Hospitals 184

Hospitals EMS Wellness 184

Taming the SRU

DECEMBER 17, 2024

compared the effects of these two among the acute gastroenteritis children and reported that the use of ORT was associated with shorter hospital stay and increased patient satisfaction. Out of 18 patients receiving ORT, 4 failed to respond well and were escalated to IV therapy. AtherlyJohn et al. A systematic review by Freedman et al.

Dehydration 84

Dehydration Fluid Resuscitation Resuscitation Administration 84

ACEP Now

MARCH 10, 2025

A sense of purpose is an integral part of well-being. Dr. Koo is faculty and an emergency physician at MedStar Washington Hospital Center in Washington, D.C., Marys Hospital in Leonardtown, Maryland. 9 Furthermore, meaningful work is a cornerstone in the longevity of career academic physicians. References Nyanchama V.

Academics 85

Academics Wellness CPR Hospitals 85

Mind The Bleep

FEBRUARY 2, 2025

However, as an F1, you may well know the patient best and therefore you may be best placed to refer the patient. Hospital/NHS number is 1234. She is otherwise in good health and is responding well to chemotherapy. Ronan is a 12yr old boy who has a suspected diagnosis of leukaemia.

Radiology 96

Radiology Radiology Sepsis Documentation/Coding 96

EMDocs

DECEMBER 18, 2024

This series provides evidence-based updates to previous posts so you can stay current with what you need to know. fold higher risk of NSTI than the control group 12 For those without comorbidities , AUD exhibited a 15.2-fold fold higher risk of NSTI than the control group 12 For those without comorbidities , AUD exhibited a 15.2-fold

Seizures 105

Seizures Hyperthermia / Hypothermia Emergency Department EMS 105

The Trauma Pro

SEPTEMBER 1, 2023

more likely In-hospital cardiac arrest – 5x The authors concluded that even if your patient does not have injuries that might limit their daily activities, it is still important to discuss goals of care with our elderly trauma patients. The point is that injuries limiting daily activities are a predictable factor for withdrawal of care.

Hospitals 198

Hospitals Wellness 198

PEMBlog

MARCH 4, 2025

Well cover its clinical presentation, epidemiology, diagnostic approach, and management, including why standard beta-lactam antibiotics wont work. Plus, well discuss whether M. The epidemiology is shifting, and infections are rising, so your hospital should have a local plan to deal with infection in your community. 2025 Feb 17.

Pediatrics 94

Pediatrics Military CDC Hospitals 94

The Trauma Pro

AUGUST 9, 2024

He spent his career at the Charity Hospital there, weathering multiple political storms over the years, as well as the big one, Hurricane Katrina. He was instrumental in achieving Level I Trauma Center status for its replacement, Interim LSU Hospital. I’ll leave you with his 18 rules of patient care.

EMS 147

EMS Hospitals Wellness 147

American Medical Compliance

NOVEMBER 29, 2024

Continuous Glucose Monitoring (CGM) technology is transforming the approach to diabetes care for healthcare providers, including endocrinologists, diabetes educators, and nurses, as well as for the patients they support. However, to maximize its benefits, healthcare providers must be well-versed in the technology.

Outcomes 105

Outcomes Wellness Operations Pediatrics 105

Emergency Medicine Journal

MARCH 25, 2025

This month’s update is by the Emergency Department Team, Wexham Park Hospital, Slough, Frimley Health NHS Foundation Trust. We used a multimodal search strategy, drawing on free open-access medical education resources and literature searches. The 1-BED.

Sepsis 52

Sepsis Emergency Department Administration Outcomes 52

Mind The Bleep

FEBRUARY 2, 2025

In some hospitals, there is an infection ward round and MDTs for selected patients, however elsewhere your phone call may be all the information micro receive about the patient whose samples they are processing. Also, in larger hospitals, virology may be a separate department with its own advice system.

Radiology 98

Radiology Radiology Documentation/Coding Hospitals 98

RebelEM

FEBRUARY 15, 2024

Additionally, intubation can risk hemodynamic instability as well as hypoxemia from the procedure itself. It is unclear, though, if the risks of intubation (including ventilator associated pneumonia) outweighs the benefits. of the risk of pneumonia by not intubating patients (NNT = 13) Additionally there was an absolute reduction of 12.2%

Poisoning 141

Poisoning Airway Management Seizures Shock 141

Pediatric EM Morsels

NOVEMBER 3, 2023

This allowed US hospitals to stock the drug to ensure quick treatment of suspected severe cases, rather than having to ship it from the CDC under the prior expanded-access protocol (Thomas 2023). Higher Rates of Misdiagnosis in Pediatric Patients versus Adults Hospitalized with Imported Malaria. Third times the charm! June 28, 2023.

Seizures 281

Seizures Pediatrics CDC Infectious Diseases 281

The Trauma Pro

JUNE 14, 2024

Patients with no other injuries could potentially be discharged from the hospital before they become overtly symptomatic, leading to delayed treatment. With newer scanners, radiologists are better able to detect subtle areas of hypoperfusion as well. These are rare, but should bring intestinal injury to mind when seen.

Operations 147

Operations Radiology Radiology Hospitals 147

Ken Grauer, MD

JULY 29, 2023

The ECG in Figure-1 was obtained from an 18-year old woman — who moments before been resuscitated from out-of-hospital cardiac arrest. An ICD ( I mplantable C ardiac D efibrillator ) was inserted — and the patient was discharged from the hospital. Epsilon waves are best seen in leads V1 , V2 — and a bit less well seen in V3,V4.

EKG/ECG 370

EKG/ECG Resuscitation Documentation/Coding Hospitals 370

Sensible Medicine

OCTOBER 15, 2024

It is my pleasure to introduce this article by Joseph Marine, MD in response to mandatory masking policies in a number of California hospitals. The State of Maryland reinstated a health care mask mandate last winter based on the state reaching a threshold of 10 RSV/flu/covid hospitalizations per 100,000 population.

Hospitals 142

Hospitals Wellness 142

Don't Forget the Bubbles

DECEMBER 31, 2024

There is little difference between being able to read the body language of a six-month-old to determine if they are irritable than there is in reading the body language of a chief executive to understand whether your report is being well received. One may argue the former is much more important to get right, though.

Leadership 140

Leadership Emergency Department Outcomes Operations 140

The Trauma Pro

JANUARY 5, 2024

The study excluded patients with chest tubes placed in other hospitals, tubes placed late (after 24 hours), or patients who had a chest procedure within 6 hours. Bottom line: Well, this was a new one for me. They noted a decrease in hospital, ICU, and ventilator days.

Hospitals 133

Hospitals Wellness Outcomes 133

Ken Grauer, MD

SEPTEMBER 15, 2024

For full discussion of the case — CLICK HERE — ECG Rhythm Overview: A 12-year-old boy was admitted to our hospital with severe myocardial dysfunction and chaotic rhythm with tachy- and bradycardic arrhythmias. ECG #2: Figure-2: ECG #2 is from the 4th hospital day.

EKG/ECG 195

EKG/ECG Hospitals Wellness 195

ACEP Now

MARCH 10, 2025

At your monthly meeting with the chief medical officer (CMO) and chief nursing officer (CNO), they inform you of the hospitals plan to start a Sexual Assault Nurse Examiner (SANE) Program. 1 There are many program models including ED-based, non-ED hospital-based, hospital, and community-based programs. You accept the position.

Sexual Assault 52

Sexual Assault Forensics Leadership Pediatrics 52

ACEP Now

MARCH 11, 2025

2-4 A study in Annals of Emergency Medicine of almost 300,000 patients hospitalized with acute PE between 2011-2020 found that the use of UFH increased from 41.9 no increase in vasopressor use, mechanical ventilation, admission to an intensive care unit, in-hospital mortality). percent to 56.3 percent despite guideline recommendations.

Hospitals 52

Hospitals Administration Outcomes Stroke 52

Mind The Bleep

FEBRUARY 2, 2025

” Yes, I have seen clerking look like this and I can confirm, it does not go down well. Examples of examination findings you might find helpful to keep in mind (list not exhaustive): GCS 15/15- alert, orientated, looks comfortable, warm and well perfused, in obvious pain, looks pale and clammy etc.

Documentation/Coding 95

Documentation/Coding COPD EKG/ECG Wellness 95

EMDocs

MARCH 12, 2025

When EMS brought him to you, they said that his heart rate was really fast, but it was only a 2-minute transport time and his blood pressure was OK, so they ran him to the hospital as quickly as they could. Well, does this patient have ventricular tachycardia? That was when he was diagnosed with the heart condition. Thats not good.

EKG/ECG 65

EKG/ECG Wellness EMS Hospitals 65

The Trauma Pro

AUGUST 8, 2023

The patient was oxygenated well and the “outside” ET tube was removed. A well-positioned ET tube was then reinserted. The patient did well afterwards. Not treated at Regions Hospital or even in Minnesota. This explained the shallow position of the tube. ” And if you need more hands, ask for assistance!

Wellness 130

Wellness Hospitals 130

Pediatric EM Morsels

JUNE 2, 2023

Our patients have varied past medical histories that require us to be well-versed in even the most uncommon disorders (or know where to look things up in a pinch)! Admission to hospital depending on severity of symptoms and need for further hydration Moral of the Morsel Diseases, just like our patients, are unique and varied!

Dehydration 193

Dehydration Shock Pediatrics Emergency Department 193

Ken Grauer, MD

FEBRUARY 3, 2024

I’ve taken th e l ead V 3 examples in Figure-3 from previous cases posted on Dr. Smith’s ECG Blog : T OP in Figure-3 — Despite the marked ST elevation in this lead V3 — this is not T-QRS-D, because there is well-defined J-point notching ( BLUE arrow ). This patient had a repolarization variant as the reason for ST elevation.

EKG/ECG 411

EKG/ECG Resuscitation Hospitals Wellness 411