Ken Grauer, MD
FEBRUARY 1, 2025
I was sent the ECG in Figure-1 obtained from a previously healthy man his 60s, who contacted EMS ( E mergency M edical S ervices ) for new-onset severe burning CP ( C hest P ain ) that radiated to the jaw and throat. On seeing the ECG in Figure-1 the EMS crew activated the cath lab. QUESTION: Do you agree with this decision by the EMS crew to activate the cath lab?
The Trauma Pro
JANUARY 28, 2025
In my last two posts, I reviewed some older papers on the efficacy of Andexxa (andexanet alfa) for the reversal of Factor Xa inhibitor anticoagulants. Those results were not very impressive, especially considering the high cost of this drug. In 2021, an article was published (reference 1) that performed a systematic review of the literature from 2017 to 2020.
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Science Based Medicine
JANUARY 29, 2025
Shrug, move on and never admit you were wrong The post The willful blindness of RFK Jrs supporters first appeared on Science-Based Medicine.
Sensible Medicine
JANUARY 28, 2025
Just out, we have a new paper on a provocative question. What factors were blamed for the 2019 Samoa measles outbreak in the peer reviewed literature and news coverage? At the time, and now 5 years later? Subscribe now First, we assembled every single peer reviewed article and mainstream media news story on the Samoa measles outbreak. 163 studies met our criteria.
Dr. Smith's ECG Blog
JANUARY 2, 2025
By Smith with comments from our electrophysiologist, Rehan Karim. (And of course Ken's comments at the bottom) An elderly obese woman with cardiomyopathy, Left bundle branch block, and chronic hypercapnea presented hypoxic with altered mental status. She was intubated. Bedside cardiac ultrasound showed moderately decreased LV function. CT of the chest showed no pulmonary embolism but bibasilar infiltrates.
ACEP Now
JANUARY 4, 2025
In recent years, emergency medicine, once the bastion of quick decision making, clinical acumen, and patient-centered care, has been quietly succumbing to a different forcethe slow but steady erosion of critical thinking. The culprit is the increasing reliance on protocolization and the diminishing autonomy of emergency physicians. This shift, intended to standardize care and mitigate error, is paradoxically undermining the very heart of medicinethe doctors ability to think critically, adapt to
PulmCCM
FEBRUARY 5, 2025
Neurologists’ job just got harder. Patients who present with ischemic stroke more than 4.5 hours after symptom onset generally do not receive intravenous thrombolytics (tPA or TNK). That’s because outside that accepted window, the risk of intracranial hemorrhage was believed to outweigh the benefits of thrombolytics in restoring blood flow to at-risk brain tissue.
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EM Ottawa
JANUARY 9, 2025
In the acute care setting, steroids have various usages and indications, but their usage can often be nuanced. From adrenal crises to septic shock, severe community-acquired pneumonia, and even acute pharyngitis, steroids play a pivotal role in managing a variety of conditions encountered in the Emergency Department (ED). However, their use is far from straightforwardbalancing […] The post These are the ‘Roids you are looking for – Steroids in the ED appeared first on EMOttawa
St. Emlyn
JANUARY 2, 2025
St.Emlyn's - Emergency Medicine #FOAMed This feasibility study described the delivery of ECMO CPR (ECPR) for the first time in the UK The post Pre Hospital Extracorporeal CPR (ECPR) in the UK: The Sub30 study appeared first on St.Emlyn's.
The Bottom Line
JANUARY 16, 2025
Whats new in the Critical Care literature monthly updates
Emergency Medicine Journal
JANUARY 21, 2025
Trauma remains a significant cause of mortality and morbidity. Non-compressible torso haemorrhage is one of the key drives of these mortality data. Our contemporary management has focused on damage control resuscitation, with a focus on haemorrhage control, haemostatic resuscitation and permissive hypotension. The evidence for permissive hypotension lacks the robustness as other treatments, such as tranexamic acid.
The Trauma Pro
FEBRUARY 14, 2025
The Advanced Trauma Life Support course lists “classes of hemorrhage”, and various other sources list a similar classification for shock. I’ve not been able to pinpoint where these concepts came from, exactly. But I am sure of one thing: you will be tested on it at some point in your lifetime. Here’s the table used by the ATLS course: The question you will always be asked is: What class of hemorrhage (or what % of blood volume loss) is the first to demonstrate systolic hy
Science Based Medicine
JANUARY 3, 2025
Once again, sheltered laptop-class doctors are treating children's health as a parlor game to advance their political objectives. The post To Spread Mistrust, Dr. Martin Kulldorff Asks RFK Jr. to do an Unethical, Impossible RCT of Vaccines He Knows Are Safe & Effective first appeared on Science-Based Medicine.
Sensible Medicine
JANUARY 23, 2025
Two health obsessions that I’ve never really understood are the supposed benefits of vitamin D (for every imaginable ill) and harm of seed oils. Dr. Bobby Dubois thinks a lot about the evidence behind health recommendations on his podcast. His research has led him to a pretty clear opinion about the role of seed oils in health and disease. Attentive Sensible Medicine readers will note that his take is a bit different from that expressed in a recent post.
Dr. Smith's ECG Blog
JANUARY 28, 2025
Written by Hans Helseth A 34 year old man with no known medical history presented to the ED after an hour of chest pain. He described the pain as a mid sternal "burning sensation" and rated it 8.5 out of 10 at onset, but on presentation to the ED, reported that the pain had improved to 4.5. His first EKG is shown below, with a lead II rhythm strip: EKG 1, 1645 A provisder who is looking for STEMI would not see much in this EKG.
ACEP Now
JANUARY 5, 2025
Its 4 a.m., and youre three hours from the nearest tertiary care center. A young woman, 13 days post-tonsillectomy, comes into your rural emergency department (ED) coughing up blood. On exam, you see bright red blood trickling down her left tonsillar fossa. Her vital signs are normal, except for a heart rate of 115 bpm. Its going to take time to get her to a tertiary center.
PulmCCM
JANUARY 2, 2025
Many randomized trials have tested the biomarker procalcitonin as a guide to de-escalate or stop antibiotic therapy in patients with known or suspected infection. A large proportion have concluded PCT is a safe and effective method to shorten antibiotic courses, including in patients with sepsis. But most such trials have been small, often single-center, and vulnerable to bias due to the unblinded nature of the intervention.
Mind The Bleep
FEBRUARY 2, 2025
This guide is designed to help you identify the key areas you need to focus on when clerking a surgical patient. There are several differences when compared to clerking a medical patient, namely getting a more extensive surgical past medical history, examination and assessing frailty. Your clerking needs to be succint, pertinent and clear. Presenting Complaint This needs to be clear and brief – a headline to tell any reader why that patient has presented: Good example: “1/7 colicky R
EM Ottawa
FEBRUARY 6, 2025
Medicine often carries an aura of mystiquea profession elevated by society as a noble calling, a higher pursuit. But for those of us in the trenches, the reality is far simpler (: medicine is a job. A demanding, high-stakes, and sometimes unforgiving job, but a job nonetheless. This isnt a dismissal of its importance but […] The post There IS Beauty in Medicine appeared first on EMOttawa Blog.
Emergency Medicine Cases
JANUARY 7, 2025
Dr. Patricia Lee is an EM physician in Calgary, Alberta and an Assistant Professor at the University of Calgary in the Department of Emergency Medicine. She reached out to me after listening to Episode 200 How EM Experts Think Part 1 as a longtime supporter of EM Cases, to highlight the importance of recognizing challenges that female-identifying EM physicians may face before, during and after ED shifts.
The Bottom Line
JANUARY 16, 2025
Whats new in the Critical Care literature monthly updates
Emergency Medicine Journal
JANUARY 21, 2025
This month’s update is by the Emergency Department of the University Hospital of Heraklion, Crete, Greece. We used a multimodal search strategy, drawing on free open-access medical education resources and literature searches. We identified the five most interesting and relevant papers (decided by consensus) and highlighted each paper’s main findings, key limitations and clinical bottom line.
The Trauma Pro
FEBRUARY 7, 2025
In my last post, I wrote about the usual reasons for delayed diagnosis: insufficient diagnostic technique or insufficient recognition. What about the time of day? An interesting paper looked at the correlation between admission time and the rate of missed injuries. The work was done at a large teaching hospital and Level I trauma center in Australia.
Science Based Medicine
FEBRUARY 4, 2025
If confirmed, Kennedy will keep trashing science and will continue exploiting the trashed science he helps create for his own benefit. The post The Trashing of Science by Robert F Kennedy Jr first appeared on Science-Based Medicine.
Sensible Medicine
JANUARY 3, 2025
Doctors of a certain age tend to fetishize the physical exam. I think this is because learning the physical exam is an important part of the socialization of the doctor. It is also a skill that doesn’t really wither with time. Though with every passing day I feel more and more like part of the old guard, I can only give the exam a tepid defense.
Dr. Smith's ECG Blog
JANUARY 7, 2025
(This was created by Arron Pearce ( [link] ) Online QT calculator for wide QRS (LBBB, RBBB, etc.
St. Emlyn
JANUARY 6, 2025
St.Emlyn's - Emergency Medicine #FOAMed How does pre-hospital emergency anaesthesia (PHEA) delivered by Helicopter Emergency Medical Services (HEMS) impacts trauma care timelines compared to emergency department RSI (EDRSI). This retrospective study explores time efficiency, injury severity, and patient outcomes, highlighting the role of HEMS in delivering critical care to severely injured patients in remote locations.
EMDocs
JANUARY 8, 2025
Authors: Lloyd Tannenbaum, MD (EM Attending Physician, Geisinger Wyoming Valley, PA); Mai Saber, DO (EM Attending Physician, Hackensack University Medical Center, NJ); Rachel Bridwell, MD (EM Attending Physician, Charlotte, NC) // Reviewer: Brit Long, MD (@long_brit) Hello and welcome back to ECG Pointers, a series designed to make you more confident in your ECG interpretations.
Mind The Bleep
FEBRUARY 2, 2025
Often one of the scariest things you can do as you will most likely be speaking to a more senior colleague in an unfamiliar speciality. However, as an F1, you may well know the patient best and therefore you may be best placed to refer the patient. Our Webinar Introduce yourself and say on whose behalf you are making the referral Remember, you hold all the information about the patient and are therefore in the driving seat Use the SBAR approach and you wont go far wrong Know why you are referrin
EM Ottawa
JANUARY 13, 2025
Methodology: 4/5 Usefulness: 4/5 Vallentin MF, et al. N Engl J Med. 2024 Oct 31. doi: 10.1056/NEJMoa2407616. Editorial: The Way to a Patient’s Heart – Vascular Access in Cardiac Arrest Question and Methods: This RCT compared IO vs. IV vascular access in adults with OHCA, using ROSC as a primary outcome. Findings: No significant difference […] The post Intraosseous or Intravenous Vascular Access for Out-of-Hospital Cardiac Arrest appeared first on EMOttawa Blog.
Emergency Medicine Cases
JANUARY 28, 2025
On this month's EM Quick Hits podcast: Anand Swaminathan on optimizing RSI medication timing, Brittany Ellison ED boarding challenges in older patients and solutions to ED crowding and flow, Dave Jeromeon managing prolonged tourniquet application, Nour Khatib and Phil Gillick on a rural peer support case, Jesse McLaren on ECG reciprocal changes in acute coronary occlusion, and Melody Ngon practical nutrition tips for shift workers.
EB Medicine
JANUARY 7, 2025
In this episode, Sam Ashoo, MD interviews Nicholas Stark, MD, MBA & Zaid Altawil, MD about the Emergency Medicine Innovation Collaborative 1. Discussion on EMIC - Overview of the collaborative - Background and formation during the pandemic in late 2021 2. Growth of EMIC - Expansion from three members to over 500 - Focus areas: Education, mentorship, opportunity 3.
Life in the Fast Lane
JANUARY 27, 2025
Michael Gibbs MD Neuroimaging Cases 007 Nail gun injury. First in our Neuroimaging case study series with Teresa Crow , Troy Carnwath, Scott DiMeo, L.
PulmCCM
JANUARY 15, 2025
Pulse oximeters for healthcare and consumer use are calibrated on patients with lighter skin. Manufacturers have recognized the devices’ suboptimal performance in darker-skinned patients for decades, but they have faced no serious regulatory or legal pressure to act. In 2013, FDA issued a suggestion that manufacturers test devices on patients “with a range of skin pigmentations.” But the standard was lax: only two darkly pigmented subjects, or 15% of the total pool were needed.
Science Based Medicine
JANUARY 6, 2025
A proponent of the Great Barrington Declaration is comparing rejection of its "natural herd immunity" approach to the pandemic to the rejection of Ignaz Semmelweis and his findings. It's a deceptive comparison beloved of all manner of scientific cranks. The post The Semmelweis gambit: A red flag for defending bad science and quackery first appeared on Science-Based Medicine.
Sensible Medicine
FEBRUARY 17, 2025
John is sick, so I have big shoes to fill. Today’s study of the week is a cancer trial. I know many of you aren’t cancer doctors, and you are thinking about skipping this essay. Let me assure you: you will learn something. The trial has issues with control arm, skewed randomization (2:1), drop out and endpoints. It is a rollercoaster ride of critical appraisal.
Dr. Smith's ECG Blog
FEBRUARY 2, 2025
Written by Pendell Meyers A man in his 60s presented with acute chest pain. Here is his triage ECG: What do you think? There is sinus rhythm with clear LVH. Leads V5-6 are suspicious for upright, enlarged T waves that are possibly inappropriate for the QRS complex, especially V6. But without a baseline for comparison, it would be difficult for me to say that it is specific and diagnostic for OMI.
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