Ken Grauer, MD
NOVEMBER 15, 2024
Today's case was contributed by Dr. Magnus Nossen ( from Fredrikstad, Norway ). Dr. Nossen was at his computer — reviewing ECGs from patients recently admitted to his group's hospital service. He came across the ECG shown in Figure-1 — obtained from a woman in her 70s who was admitted to the hospital for new CP ( C hest P ain ). QUESTION: How would YOU interpret the ECG in Figure-1 ?
The Trauma Pro
NOVEMBER 8, 2024
Patients with severe TBI frequently undergo surgical procedures to remove clot or decompress the brain. Most of the time, they undergo a craniotomy, in which a bone flap is raised temporarily and then replaced at the end of the procedure. But in decompressive surgery, the bone flap cannot be replaced because doing so may increase intracranial pressure.
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Pediatric EM Morsels
NOVEMBER 15, 2024
Seizures are super scary for a parent to witness, but not all seizures mean danger. There is actually a diagnosis of seizures that has “ BENIGN” in the name! Have you ever had that feeling of falling that rapidly wakes you from sleep? While it’s unlikely that you were having Benign Epilepsy with CentroTemporal Spikes (BECTS) seizures or a benign Rolandic seizure, that tenuous state between sleeping and waking is a time when some odd neurologic things can happen, including BECTS.
Stop and Think
NOVEMBER 19, 2024
The OPTION trial compared two strategies to reduce stroke and bleeding after catheter ablation of atrial fibrillation. The current strategy is to continue an anticoagulant medication. The alternative tested in OPTION is to implant a left atrial appendage device—abbreviated as LAAC (left atrial appendage closure). AF ablation is one of the most common procedures in my field.
Science Based Medicine
NOVEMBER 8, 2024
Doctors who are concerned about members of our profession enabling powerful anti-vaxx disinformation agents should speak up before it's too late. But its probably too late already. The post Robert Kennedy Jr. & His Doctor Friends May Just Be Getting Started first appeared on Science-Based Medicine.
Sensible Medicine
NOVEMBER 4, 2024
Nearly a thousand news outlets covered the recent publication of the positive results of the STEP-9 trial of semaglutide vs placebo for the treatment of knee pain due to osteoarthritis in patients with obesity. Twitter overflowed with positive messages after the New England Journal of Medicine publication. I am not sold on the trial. STEP-9 had many flaws but one fatal flaw.
Ken Grauer, MD
NOVEMBER 9, 2024
I was asked to interpret the ECG in Figure-1 — told only that this 30-ish year old man had a history of having undergone a number of operations for CHD ( C ongenital H eart D isease ) as a child. QUESTIONS: In Figure-1 — Is the rhythm VT — or — SVT with aberrant conduction — or — potentially neither of these possibilities? IF told that this patient was hypotensive in association with the rhythm in Figure-1 — Does It Matter what the specific etiology of this rhythm is?
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St. Emlyn
NOVEMBER 6, 2024
St.Emlyn's - Emergency Medicine #FOAMed Creating a learning culture in the emergency department (ED) fosters psychological safety, open communication, and continuous improvement. This approach supports team resilience, enhances patient care, and reduces burnout. Learn practical steps to build a strong learning culture in your ED, promoting growth and collaborative excellence in emergency medicine.
Dr. Smith's ECG Blog
NOVEMBER 14, 2024
This was texted to me by a paramedic while I was out running one day: "54 yo male chest pain started at 1pm. History of diabetes type II and stent placement in 2018. I’m seeing hyperacute T waves III, aVF, down sloping depression I and aVL. Thoughts?" What do you think? I responded: "Definite inferior OMI. And Right Ventricular. Activated the Cath Lab.
Science Based Medicine
NOVEMBER 15, 2024
When RFK Jr. does to the U.S. what he did to Samoa, doctors will say they are horrified, that they love vaccines, blah blah blah. But it will be too late. The post If You Sanewashed RFK Jr., Or If You Sanewashed Doctors Who Did, You Own the Next 4 Years first appeared on Science-Based Medicine.
First 10 EM
NOVEMBER 11, 2024
In the most recent BroomeDocs podcast, we talk about an attempt to use the IM route to give cardiac arrest victims epinephrine faster. (The podcast and Research Roundups blog post might actually come out next week.) I was skeptical about the outcomes, partly because the evidence that epinephrine helps at all in cardiac arrest is […] The post IV versus IO for cardiac arrest (PARAMEDIC3 and IVIO) appeared first on First10EM.
Ken Grauer, MD
NOVEMBER 1, 2024
I was sent this ECG recording — and asked for my interpretation of the rhythm in Figure-1. I had little clinical information. QUESTIONS: How was I able to guess the probable correct answer in less than 5 seconds? How was I then able to prove that my guess was correct? Figure-1: The initial ECG in today's case. ( To improve visualization — I've digitized the original ECG using PMcardio ).
The Trauma Pro
NOVEMBER 1, 2024
Every trauma center has a massive transfusion protocol (MTP). But every trauma center also does it entirely differently. Ideally, an MTP is designed with the resources available at the hospital in mind. These may include whole blood, the use of O- vs. O+ blood, the number of units of each product per cooler, the different products in different coolers, and personnel available to move those coolers to the correct locations.
St. Emlyn
NOVEMBER 19, 2024
St.Emlyn's - Emergency Medicine #FOAMed Traditionally, large-bore chest tubes have been standard for managing hemothorax, but smaller tubes are now proving just as effective in stable patients, with added benefits like reduced pain and fewer tube days. This review explores outcomes in drainage efficacy, complication rates, and patient comfort, showing that small-bore thoracostomy may be a reliable alternative for non-emergent cases.
RebelEM
NOVEMBER 13, 2024
Take Home points : Always suspect an open joint if there is a laceration, regardless of size, the lies over joint CT scan of the affected joint is widely considered to be the standard approach to evaluation but the saline load test may be useful in certain circumstances. Obtain emergency orthopedics consultation for all open joints and administer antibiotics and update tetanus in all patients REBEL Core Cast 131.0 – Traumatic Arthrotomy Click here for Direct Download of the Podcast.
Science Based Medicine
NOVEMBER 1, 2024
Any doctor who is unabashedly pro-vaccine has already spoken up about the normalization of anti-vaxx quackery within our ranks. The post If RFK Jr. Turns the CDC Into An Anti-Vaxx Propaganda Outfit, I Don’t Want To Hear a Peep From Some “Respectable” Doctors first appeared on Science-Based Medicine.
PulmCCM
NOVEMBER 14, 2024
Critically ill patients receiving mechanical ventilation are highly prone to developing severe weakness and long-term disability. Although early mobilization and physical therapy for vented patients would intuitively seem to have indisputable benefits, early mobility programs have failed to consistently show improvements in meaningful patient-centered outcomes (e.g, increased functional independence or exercise ability after ICU discharge).
Sensible Medicine
NOVEMBER 5, 2024
A few month ago, we were pleased to publish a critical appraisal written by a group of students at the Wayne State University School of Medicine. The group is back with another piece about a recent article. I am enjoying this way of encouraging critical appraisal in undergraduate medical education and generating good content for Sensible Medicine. As below, please take this opportunity to appraise the appraisers.
ACEP Now
NOVEMBER 6, 2024
Native American emergency physicians make up 0.1 percent of physicians in U.S. emergency departments, according to research published in 2020 in Annals of Emergency Medicine. Three Native American emergency physicians in Oklahoma—three of five in the state—discussed with ACEP Now their approach to health care and how their careers in medicine began.
Life in the Fast Lane
NOVEMBER 2, 2024
Mike Cadogan Waiting Room Medicine With exponential Emergency Department over-crowding and spiraling waiting times, the Utopian College has produced a series of guidelines to assist fondling members.
The Skeptics' Guide to EM
NOVEMBER 2, 2024
Date: October 29, 2024 Reference: Galili et al. Low dose ketamine as an adjunct to morphine: a randomized controlled trial among patients with and without current opioid use. AEM Oct 2024. Guest Skeptic: Dr. Neil Dasgupta is an emergency medicine physician and ED intensivist from Long Island, NY. He is the Vice Chair of the Emergency Department and Program Director of the EM residency program at Nassau University Medical Center in East Meadow, NY, the safety net hospital for Nassau County.
Science Based Medicine
NOVEMBER 16, 2024
It means pertussis and measles outbreaks will be happening under your watch and you'll be held responsible while your boss is an anti-vaxx crank. Enjoy! The post What Does it Mean to Own the Next 4 Years? first appeared on Science-Based Medicine.
PulmCCM
NOVEMBER 11, 2024
The DanGer-Shock randomized trial allowed interventional cardiologists to breathe a bit easier, knowing that the Impella device resulted in improved survival 6 months after ST-elevation myocardial infarction with cardiogenic shock: The trial also underscored the high risks associated with the Impella device: Many more patients with Impellas required renal replacement therapy (41.9% vs 26.7%).
Sensible Medicine
NOVEMBER 15, 2024
“What kind of a doctor are you?” “I’m a general internist.” “Like an intern?” Laughing, “Don’t you think I’m too old to be an intern? No, I do general internal medicine, mostly outpatient primary care, but I do some inpatient general medicine as well.” “Oh, so you’re like a GP.” “Sort of… ” Sensible Medicine is a reader-supported publication.
ACEP Now
NOVEMBER 6, 2024
A gravid woman presents to your emergency department (ED). Before you can obtain any history, she gives birth in your waiting room. The neonate is apneic and has a heart rate of 48. How do you stabilize this patient? Neonatal resuscitation is common; 10 percent of the four million newborns in the U.S. each year will require at least some intervention. 1 However, one percent of births will require advanced interventions, including chest compressions, intubation, and medications. 2 These rare scen
Life in the Fast Lane
NOVEMBER 7, 2024
Mike Cadogan November 8, 1895 On November 8, 1895 Wilhelm Röntgen, chair of physics at Würzburg, noted an unusual phenomenon, that would change the world of medicine
American Medical Compliance
NOVEMBER 8, 2024
In healthcare settings, injuries among staff and patients are unfortunately not uncommon. According to a National Institutes of Health article , there are 34.1 total injury incidences for all professions per 1,000 healthcare workers. Additionally, according to the World Health Organization, around 1 in every 10 patients is harmed in health care. Incidents can happen even with the best protocols in place.
Science Based Medicine
NOVEMBER 10, 2024
Mass purges and prosecutions of scientists have happened before. We shouldn't pretend they can't happen here. The post Dr. Vinay Prasad: “I Don’t Believe in Forgiveness Because in My Opinion These Pieces of S**t Are Still Lying.” first appeared on Science-Based Medicine.
PulmCCM
NOVEMBER 7, 2024
During cardiac arrest, every second matters (at least potentially). For out-of-hospital cardiac arrest in particular, intravenous access can be difficult to establish, delaying the administration of epinephrine and other drugs and possibly worsening outcomes. Intraosseous (IO) devices—inserted by punching a needle loaded on a trocar into the tibia or femur—can be placed more easily than IV catheters, leading to faster injection of epinephrine.
Sensible Medicine
NOVEMBER 11, 2024
We learn in high school that the purpose of science is to ask and answer questions about nature--through experiments. Scientists don’t know the results of an experiment beforehand, so, any result, negative or positive, adds knowledge. Medical science should work the same way. Medical scientists would design and conduct experiments to answer important questions, say, whether a drug or surgery, improves an outcome.
Emergency Medicine Cases
NOVEMBER 12, 2024
In this EM Cases main episode podcast, we tackle the complexities of trauma airway management, including direct trauma to the airway. We discuss indications and timing of intubation, penetrating neck trauma, the head injured patient, the agitated patients and the soiled airway. The critical question is: when should we deviate from, delay or modify RSI, and how do we navigate the unique challenges presented by trauma airways and airway trauma?
St. Emlyn
NOVEMBER 5, 2024
St.Emlyn's - Emergency Medicine #FOAMed At the Tactical Trauma 24 conference in Sundsvall, Sweden, St Emlyn’s hosts Iain Beardsell and Liz Crowe had the opportunity to speak with Alice Hutin, an emergency physician with Service […] The post Podcast – Prehospital eCPR with Alice Hutin at Tactical Trauma 2024 appeared first on St.Emlyn's.
EMDocs
NOVEMBER 19, 2024
Authors: Bricey Bayonnet, MD ( EM Resident Physician, Atrium Health’s Carolinas Medical Center, Charlotte, NC); Christine Murphy, MD (EM Attending Physician; Medical Toxicologist, Atrium Health’s Carolinas Medical Center, Charlotte, NC) // Reviewed by: James Dazhe Cao, MD (@JamesCaoMD, Associate Professor of EM, Medical Toxicology, UT Southwestern Medical Center, Dallas, TX); Anthony Spadaro MD, (@TSpadaro91, Fellow in Medical Toxicology, Rutgers NJMS); Alex Koyfman, MD (@EMHighAK); Brit Long, M
Critical Care North Hampton
NOVEMBER 2, 2024
“Quick Draw Anatomy for Medical Students” by Joanna Oram Fox is a unique educational book designed to help medical students learn anatomy through drawing. It provides step-by-step instructions on drawing, understanding, and interpreting key anatomical structures. Her fantastic methodology for learning by illustration really impressed us with her first book!
PulmCCM
NOVEMBER 4, 2024
“I can’t prove it was the reason, but we kept everyone’s K over 4 and Mag over 2 and we didn’t have a single code this month.” – my senior resident on an internal medicine rotation, circa 2005 As many as one-fifth of hospitalized patients develop hypokalemia, commonly defined as serum potassium less than 3.5 mEq/L.
Sensible Medicine
NOVEMBER 8, 2024
I was pretty proud of my post last Friday, Screening Can Do Silent Harm. I described five cases that demonstrated the silent harms of screening. Unfortunately, unless you were both REALLY clued into the potential harms of screening AND basically live inside my head, the post left something to be desired. Reactions on twitter and in the comments were well-represented by these two: “It’s an odd article as people not already in the know won’t realise what it’s about !
EM Literature of Note
NOVEMBER 4, 2024
It is clear LLMs have an uncanny ability to find associations between salient features, and to subsequently use those associations to generate accurate probabilistic lists of medical diagnoses. On top of that, it can take those diagnoses and use its same probabilistic functions to mimic the explanations it has seen in its training set. A powerful tool – clearly an asset to patient care?
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