Ken Grauer, MD
MARCH 1, 2024
I was sent the 2 ECGs shown in Figure-1 — which were recorded from an elderly man whose heart beat "has been irregular for years". No clear history for recent chest pain — but the patient "has not been well" for the previous week. Regarding the 2 ECGs in Figure-1 : ECG #1 is the initial tracing obtained at the scene by the EMS ( E mergency M edical S ystems ) team — in association with an alert but markedly hypotensive patient.
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. This situation was first documented in a paper published in the 1960s, which noted that VIP patients have worse outcomes. Who is a VIP? It may be a celebrity. A family member. Or even a colleague.
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Pediatric EM Morsels
JULY 19, 2024
Previously, we covered Post-Tonsillectomy Hemorrhage and how we hope that “all bleeding eventually stops: ideally, by means that we have imposed rather than by exhaustion of the patient’s RBC resources.” Since the original morsel ( way back in 2012 ), the literature has shown that there are a few extra ingredients that we can add to our morsel recipe when we care for children with post-tonsillectomy hemorrhage.
Mount Sinai EM
OCTOBER 10, 2024
The Case: A woman in her twenties with no significant medical history presents with one month of progressive frontal headaches radiating to her occiput. Her headaches have been intermittent, however over the past few days she has had a few episodes of vomiting and brief episodes of blurred vision. Her headache is 8/10 currently. Last emesis and blurred vision were both 12 hours prior.
Don't Forget the Bubbles
NOVEMBER 11, 2024
One-liner… Traumatic brain injury (TBI) is a leading cause of mortality and morbidity in paediatric populations, and fever is associated with worse outcomes. Should we aim to prevent fever, or should we cool patients? A 12-year-old boy presents with a significant head injury following a road traffic accident. At the scene, his lowest GCS was 5 (E1V2M2).
RebelEM
NOVEMBER 6, 2024
Elbow Dislocation Definition: Disarticulation of the proximal radius & ulna bones from the humerus Epidemiology: Incidence Second most common joint dislocation (after shoulder) in adults Most commonly dislocated joint in children Accounts for 10-25% of all injuries to the elbow ( Cohen 1998 ) Posterolateral is the most common type of dislocation (80%) Demographics Most commonly affects patients between ages 10-20 years old As age increases, elbow dislocation rates tend to d
Sensible Medicine
SEPTEMBER 19, 2024
Dr. Marty Makary has a powerful new book, BLIND SPOTS: When medicine gets it wrong and what it means for our health , that came out on Tuesday and instantly hit #2 bestselling book on Amazon. I loved the book and highly recommend it. In this piece, he discusses one of those blind spots of the modern medical establishment—America is getting sicker right before our eyes.
Emergency Care Today brings together the best content for emergency care practitioners from the widest variety of industry thought leaders.
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
JUNE 17, 2024
Written by Bobby Nicholson, MD 67 year old male with history of hypertension and hyperlipidemia presented to the Emergency Department via ambulance with midsternal nonradiating chest pain and dyspnea on exertion. Pain improved to 1/10 after EMS administers 324 mg aspirin and the following EKG is obtained at triage. What do you think? If this EKG were handed to you to screen from triage without any clinical information, what would you think?
First 10 EM
APRIL 2, 2024
Give your patients a break. Nobody is a perfect diagnostician. Not even the best trained physician can determine, with 100% accuracy, which patients have serious pathology. Even with advanced testing, we aren’t close to perfect. However, if you listen to the subtext of breakroom complaints, it seems like we expect patients to be better diagnosticians […] The post Are you a perfect diagnostician?
Ken Grauer, MD
MARCH 27, 2024
I was sent the ECG in Figure-1 — with the following history: The patient is a young man in his early 20s — who presents to the ED ( E mergency D epartment ) because of SOB ( S hortness O f B reath ) that had been ongoing for several hours. No chest pain. He reports a number of similar previous episodes over the past few years ( although apparently has not been formerly evaluated for this ).
The Trauma Pro
OCTOBER 22, 2024
Today’s post is directed to all those prehospital trauma professionals out there. Car crashes account for a huge number of injuries worldwide. About 40% of people involved are trapped in the vehicle. And unfortunately, entrapped individuals are much more likely to die. There are four basic groups (and their category in parentheses) of trapped car occupants : those who can self-extricate or extricate with minimal assistance (self-extrication) individuals who cannot self-extricate due to pai
Pediatric EM Morsels
MARCH 29, 2024
Often our job requires us to consider the presence of needles of significant illness in the haystack of nonspecific symptoms. With the help of our favorite geneticist , Dr. Liz Baker, we will dive into the haystack headfirst and find those needles. Hopefully, without getting poked. Let’s consider Inborn Errors of Metabolism Presenting in the ED : Inborn Errors of Metabolism: Basics Common Presentations, Uncommon Kiddos For the child with lethargy, vomiting, acidosis, hypoglycemia , organom
Mount Sinai EM
AUGUST 7, 2024
Ultrasound during cardiac arrest has quickly become standard. Initially, data suggested that the use of ultrasound during arrest increased pauses between compressions which worsens outcomes. To decrease time between compressions, many protocols were proposed (see here ). One such protocol that successfully decreased time between compressions is the CASA (Cardiac Arrest Sonographic Assessment) protocol.
EMCrit
DECEMBER 1, 2024
John Holcomb, author of the PROPPR trial, on massive transfusion in 2024 EMCrit Project by Scott Weingart, MD FCCM.
EM Ottawa
JANUARY 25, 2024
Mechanical ventilation has a lot of nuance associated with it, but a lot of reference guides focus on care in the ICU. There is certainly a need for more practical application for the ED doc or initial setup of patients on the vent. With both ER and ICU experience, this post acts as a quick […] The post Mechanical Ventilation Basics appeared first on EMOttawa Blog.
Sensible Medicine
JULY 25, 2024
Atle Freithem and colleagues report in the British Medical journal the results of a pragmatic randomized control trial. The take-home message is that wearing a surgical mask for 2 weeks during the winter season of 2023 reduced the spread of self-reported viral illness. According to some, the study proves masks work. First, I commend the authors for running a randomized control trial.
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.
St. Emlyn
JULY 9, 2024
St.Emlyn's - Emergency Medicine #FOAMed A podcast with Steve Smith ECG educator extraordinaire where we discuss occlusive myocardial infarction and the future of AI and ECG interpretation. The post Podcast – Occlusive Myocardial Infarction, ECGs and Artificial Intelligence with Steve Smith appeared first on St.Emlyn's.
Dr. Smith's ECG Blog
OCTOBER 20, 2024
Written by Magnus Nossen The patient in today's case is a male in his 70s with hypertension and type II diabetes mellitus. His wife contacted the ambulance service after the patient experienced an episode of loss of consciousness. The syncope lasted about 2-3 minutes according to his wife. He woke up alert and with chest pain which he also had experienced intermittently over the previous few days.
RebelEM
FEBRUARY 15, 2024
Background: Patients with decreased level of consciousness due to alcohol, drugs, or medications commonly present to the ED. These patients can be at risk of vomiting and aspiration and often prompts clinicians to pursue definitive airway management to avoid pneumonia and other complications. It is unclear, though, if the risks of intubation (including ventilator associated pneumonia) outweighs the benefits.
Ken Grauer, MD
OCTOBER 10, 2024
I was sent the ECG shown in Figure-1 — told only that the patient was a middle-aged man with septicemia. QUESTIONS: Is this rhythm too fast to be sinus tachycardia? Are flutter waves hidden within the QRS and T waves? Are we seeing the retrograde P waves of AVNRT? Is this ATach ( A trial T achycardia )? Figure-1: The initial ECG in today's case. MY Thoughts on Today’s CASE: In my opinion — none of the above answers are optimal to describe the rhythm 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.
Pediatric EM Morsels
APRIL 19, 2024
Trauma season is at hand and like all other pediatric emergency departments in the country, we find our ED breaking ( pun intended ) at the seams with orthopedic injuries. We see all different flavors of upper extremity injuries. Yes, we’re talking about your clavicular , proximal humeral, supracondylar, lateral condylar , scaphoid and metacarpal fractures.
Critical Care North Hampton
JANUARY 25, 2024
Many thanks to Dr Manoj Wickramsinghe for his review of this fabulous POCUS textbook. He is a trainee in Anaesthesia and ICM, based in Leeds, and one of the CCN editorial team. About the book authors Editors; Hatem Soliman-Aboumarie, Marcelo Haertel Miglioranza, Luna Gargani, Giovanni Volpicelli. The authors and editors of this book include some.
EMCrit
AUGUST 26, 2024
We often joke that the right ventricle is the “forgotten ventricle,” but there is a sad truth behind this joke. Recently, there has been increased recognition of the importance of right ventricle failure and systemic congestion within some circles (e.g., nephrologists and resuscitationists). However, overall the right ventricular failure continues to be commonly overlooked.
Emergency Medicine Cases
APRIL 2, 2024
In this part 2 of our 2-part podcast on asthma with Dr. Sameer Mal and Dr. Leeor Sommer, we dig into the recognition and management of life-threatening asthma. We answer such questions as: what are the key elements in recognition of threatening asthma? What are the most time-sensitive interventions required to break the vicious cycle of asthma? What are the best options for dosing and administering magnesium sulphate, epinephrine, fentanyl and ketamine in the management of the crashing asthmatic
Sensible Medicine
JUNE 6, 2024
The first two weeks of March 2020 were jolting. Governments read the Imperial College London report (modeling a million deaths in the US), watched horrifying scenes in Bergamo (a city with median age in the 80s fyi), and collectively embraced policies that had no precedent in human history: The global closing of borders, schools, business, and the use of the police state to enforce this lockdown.
Science Based Medicine
NOVEMBER 22, 2024
Had laptop class doctors been willing to listen to doctors who worked on COVID units, they wouldn't have said so many absurd things. The post Laptop Class Doctors Think Doctors Who Treat Patients Are Lazy, Dumb, Cowardly, Sheep first appeared on Science-Based Medicine.
First 10 EM
JUNE 24, 2024
A can’t intubate can’t oxygenate scenario will always be scary, but after years of mental rehearsal and some real world experience, the idea of surgical front of neck access in an adult doesn’t bother me much. (I think that is an important mental space for emergency physicians to find if you want to be able […] The post The pediatric can’t intubate can’t oxygenate scenario (Use a knife) appeared first on First10EM.
Dr. Smith's ECG Blog
FEBRUARY 22, 2024
Written by Pendell Meyers A woman in her 30s called EMS for acute symptoms including near-syncope, nausea, diaphoresis, and abdominal pain. EMS arrived and found her to appear altered, critically ill, and hypotensive. An ECG was performed: What do you think? Extremely wide complex monomorphic rhythm just over 100 bpm. The QRS is so wide and sinusoidal that the only real possibilities left are hyperkalemia or Na channel blockade.
RebelEM
MAY 27, 2024
Background: The REVERT Randomized Controlled Trial demonstrated the superiority of the modified valsalva maneuver (MVM) over the standard valsalva maneuver (VM) in re-establishing normal sinus rhythm (NSR) in patients with PSVT (Appelboam 2015). MVM exaggerates venous return to the heart and increases vagal outflow by elevating the patient’s legs.
Ken Grauer, MD
JUNE 22, 2024
The ECG in Figure-1 — was obtained from a middle-aged woman with positional tachycardia and diaphoresis with change of position from suprine to sitting. Although CP ( C hest P ain ) was not a prominent symptom — ACS ( A cute C oronary S yndrome ) was suspected from the chest lead T wave inversion seen on this ECG. QUESTIONS: How would YOU interpret the ECG in Figure-1 ?
The Trauma Pro
MARCH 1, 2024
Seriously injured patients frequently develop coagulopathy, which makes resuscitation (and survival) more challenging. A few years ago, the CRASH-2 study lent support for using tranexamic acid (TXA) in select trauma patients to improve survival. This drug is cheap and has antifibrinolytic properties that may be beneficial if given for life-threatening bleeding within 3 hours of initial injury.
Pediatric EM Morsels
AUGUST 23, 2024
Concussions are commonly encountered in the Emergency Department. We have previously discussed an approach to the question of when a patient “ can return to sport.” That recommendation has been revised ( calling for us to Rebake this Morsel ) and now also pays specific attention to the important aspect of scholastic activities. Let’s take a quick minute to digest a morsel on the current concussion in sport recommendations with respect to Return to Learn and Return to Sport : Re
EM Ottawa
MARCH 14, 2024
Posterior circulation ischemia accounts for approximately 20-25% of all ischemic strokes and is a significant cause of patient disability. The diagnosis can be extremely challenging as findings are often not typically focal. Posterior strokes are misdiagnosed more than 3x more often than anterior circulation strokes.1 Similar to anterior circulation strokes, posterior strokes are most commonly […] The post Posterior Circulation Strokes appeared first on EMOttawa Blog.
Stop and Think
MARCH 31, 2024
My career in cardiology can be separated into two decade-long blocks. The first decade I practiced like most other cardiologists. I went with the flow, followed the guidelines. I went to few meetings, read few studies and as a result had little (mental) tension. Then I started writing about medical evidence. This required studying the evidence. Over time, I learned the skill of critical appraisal.
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