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

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

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

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 95

Hospitals CPR EMS Outcomes 95

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

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 407

EKG/ECG Wellness Hospitals 407

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

RebelEM

AUGUST 21, 2023

Mild Hypercapnia or Normocapnia after Out-of-Hospital Cardiac Arrest. PMID: 37318140 Clinical Question: Does mild hypercapnia in adults with coma who have been resuscitated following out-of-hospital cardiac arrest provide favorable neurological outcomes in 6 months compared to normocapnia? Paper: Eastwood G, et al. N Engl J Med.

Hospitals 98

Hospitals Resuscitation Outcomes CPR 98

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 187

Hospitals EMS Wellness 187

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

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.

Hospitals 147

Hospitals EMS Wellness 147

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

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

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

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 278

Seizures Pediatrics CDC Infectious Diseases 278

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

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

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 136

Hospitals Wellness 136

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

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 21, 2024

Antibacterial ointments , like bacitracin, tend to be well tolerated and promote faster wound healing than silver sulfadiazine and other creams in partial thickness wounds. Ointment has shorter half-life, so should be cleansed and changed every 12 hours. Get the Goop! Halt the Hurt! Phone a friend. References : Palmieri TL, Greenhalgh DG.

Burns 169

Burns Pediatrics Hospitals Wellness 169

The Trauma Pro

OCTOBER 6, 2023

At the time, there was a debate about whether the procedure should be done immediately versus waiting until the patient was well-resuscitated. This was a big procedure, with the possibility of several major complications, with postop paraplegia being one of them. The concern was that death was nearly certain if the aortic lesion progressed.

Head Injuries 147

Head Injuries Research Hospitals Resuscitation 147

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 189

Dehydration Shock Pediatrics Emergency Department 189

RebelEM

JUNE 1, 2023

Background: Achieving ROSC in out of hospital cardiac arrest (OHCA) is no easy feat but, care doesn’t end with ROSC. Excluded: Obvious cause for OHCA prior to SDCT or on hospital arrival. The cost difference may be modest here as many of the patients in the standard care cohort were getting CTs as well. IQR 2.2 – 69.5)

Outcomes 145

Outcomes Resuscitation Hospitals CPR 145

The Trauma Pro

JULY 5, 2024

But under-prescribing can create problems as well. Uncontrolled pain is a huge patient dissatisfier, and can lead to unwelcome complications as well (think pneumonia after rib fractures). Make sure all is documented well on the consent or in the EHR.

Documentation/Coding 113

Documentation/Coding Fractures Emergency Department Wellness 113

Emergency Live

JUNE 21, 2024

Each ship has a medical center with hospital beds, diagnostic equipment such as ECG and X-ray machines, and a well-stocked pharmacy. Medical Facilities and Specialized Personnel On Board Cruise ships are like floating cities equipped with state-of-the-art medical facilities to handle any health emergency.

EKG/ECG 97

EKG/ECG Hospitals Wellness 97

The Trauma Pro

OCTOBER 25, 2024

To sum up, both are equally effective in controlling hemorrhage, but the hospital costs for patients undergoing angioembolization are significantly less. Authors from several well-known trauma centers collaborated to re-analyze data from the CLOTT study. The primary outcome was the development of VTE during the hospitalization.

Fractures 113

Fractures Head Injuries Operations Ultrasounds 113

Pediatric EM Morsels

FEBRUARY 2, 2024

Hospitalization for travel-related illness are around 10% for both VFR and tourists (Leuthard 2015) Multiple studies have reported the most common travel infections in various countries. Infectious Disease Acquisition in Pediatric International Travelers: A 10-Year Review at a Canadian Tertiary Care Hospital. Pediatr Emerg Care.

Infectious Diseases 161

Infectious Diseases Pediatrics Sepsis Documentation/Coding 161

ACEP Now

OCTOBER 10, 2024

He completed residency in emergency medicine through Emory while training at Grady Hospital in Atlanta. Most recently, Dr. McCormick served as an emergency physician at Northside Hospital. In the Atlanta region, we had AMC, one of the largest hospitals in the region closed. Overburden the other hospital systems.

Critical Access 105

Critical Access Telemedicine Hospitals Administration 105

University of Maryland CC Project

AUGUST 18, 2024

Colin Grissom is professor of medicine at Intermountain Healthcare as well as University of Utah. He discusses his experience with implementing best practices, specifically low tidal volume ventilation, across […] Dr. Colin Grissom is professor of medicine at Intermountain Healthcare as well as University of Utah.

Best Practices 81

Best Practices Wellness Hospitals 81

Sensible Medicine

OCTOBER 20, 2024

I would strongly encourage you to pursue medicine if… Your primary goal in a career is using your talents to improve the well being of others. You want to be a hospital CEO. Don’t do medicine if you don’t do well when things don’t go according to plan. Here is my answer (leave yours in the comments).

Wellness 135

Wellness Hospitals 135

Sensible Medicine

AUGUST 12, 2024

Surely you do as well. You can improve your chances by eating well, exercising, avoiding smoking and too much alcohol. What patients, doctors, hospitals and payers want to know is that does the $43 billion spent on screening lead to better outcomes in the average patient. Most hospitals have dedicated sections for screening.

Outcomes 126

Outcomes Research Wellness Hospitals 126

Taming the SRU

MARCH 12, 2024

ED visits per 1000 adults with diabetes based on 2018 data resulting in over 500,000 annual hospital days. This amounts to annual hospital costs of $5.1 as well as patients less than 18 years old were excluded from analysis. DKA accounts for approximately 223,000 ED visits annually or 8.9

Operations 96

Operations Hospitals Best Practices Wellness 96

Ken Grauer, MD

AUGUST 29, 2024

The patient was offered EP ( E lectro P hysiologic ) study — but she refused, since she "was feeling well". She was discharged from the hospital on Amiodarone. Cardiac cath — showed no significant coronary disease. A cknowledgment : My appreciation to Jean Max Figueiredo ( from Nova Iguaçu, Brazil ) for the case and this tracing.

EKG/ECG 392

EKG/ECG Hospitals Wellness 392

Don't Forget the Bubbles

AUGUST 26, 2024

While enjoying a well-deserved lunch break recently, a group of Paediatric Registrars and I discussed the usual topics of family-friendly dinners, recent interesting cases from the birth centre and fun scrub tops. As is typical in a large teaching hospital, this dialogue progressed to staffing levels and skill mix in Paediatrics.

Hospitals 98

Hospitals Wellness 98

The Trauma Pro

APRIL 26, 2024

In the last post in the series, I’ll discuss a paper in press that compares the efficacy and hospital charges of the two techniques. Years ago, we tried to pack the pelvis from the inside (peritoneal cavity), but it never worked very well. As I continue to preach, going anywhere but the OR is dangerous for the patient.

Fractures 147

Fractures Head Injuries Radiology Radiology 147

Sensible Medicine

JUNE 28, 2024

A 76-year-old woman presents to a community hospital after waking with garbled speech and right-sided weakness. Case 1: Excess An elderly woman is admitted to a community hospital with a minor stroke. The hospital does an excellent job. By the time she leaves the hospital, she has no residual symptoms. I love my job.

Stroke 94

Stroke Academics Hospitals EKG/ECG 94