Ken Grauer, MD

SEPTEMBER 22, 2023

Note also that the P wave is negative in standard lead II in Figure-1 ( as well as in leads III and aVF, which are the other 2 inferior leads ). It is well to remember that IF the P wave in lead II is negative — then by definition — You do not have sinus rhythm ( unless there is lead misplacement or dextrocardia ).

EKG/ECG 442

EKG/ECG Wellness 442

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

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 ECG in Figure-1 — was obtained following successful resuscitation. A C loser L ook at Today's ECG: The rhythm in Figure-1 is sinus — with regular upright P waves with a constant and normal PR interval in lead II.

EKG/ECG 434

EKG/ECG Resuscitation Hospitals Wellness 434

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). In the US, it is usually a physician and typically a surgeon.

Airway Management 197

Airway Management Operations Hospitals Wellness 197

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.

Documentation/Coding 290

Documentation/Coding Outcomes Hospitals Wellness 290

The Trauma Pro

MAY 24, 2024

Although gastric repair is usually simple and heals well, his group did note a few severe complications. It’s probably a good idea for concomitant colon injury as well, but there’s less literature support. Of 243 patients with this injury, 15 developed ones that were considered severe, and 10 of those were empyema!

Operations 203

Operations Wellness 203

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. Ever been in a trauma activation where it seems like the first thing that happens is that someone steps up to the patient with the ultrasound probe in hand?

Resuscitation 214

Resuscitation Ultrasounds Hospitals Wellness 214

The Trauma Pro

AUGUST 14, 2024

They occasionally crash when we think everything is going so well. They continually surprise us, sometimes for the better when they recover more quickly and completely than we thought. But sometimes it’s for the worse. The crashing patient is in obvious need of help and most trauma professionals know what to do.

Radiology 201

Radiology Radiology Operations Resuscitation 201

The Trauma Pro

MAY 21, 2024

And if there is a large difference in mass between the vehicles, there are some other calculation nuances as well. If the impact is angled there is a little trigonometry involved, which I will avoid in this example. In this example, since the masses are the same, each vehicle would come to a stop on impact because the masses are equal.

Wellness 233

Wellness 233

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. They are timeless and will serve you well regardless of your degree and level of medical training. I’ll leave you with his 18 rules of patient care.

EMS 147

EMS Hospitals Wellness 147

The Trauma Pro

APRIL 2, 2024

A Brief Report in the British Medical Journal Open shows us what may very well be the next stage in treating these injuries. It may very well eliminate the need for a diverting colostomy. Ditto for the distal rectal washout. So we have been performing a diverting colostomy as the primary method of treatment for years.

Wellness 147

Wellness 147

The Trauma Pro

JUNE 4, 2024

They also need to stick well to a chest wall, which may have blood or other fluids that might disrupt the seal completely. To avoid this, a number of vented products have been developed and approved by the US Food and Drug Administration (FDA).

Administration 214

Administration Research Wellness 214

Ken Grauer, MD

JANUARY 5, 2024

Note the uncanny similarity in duration of the R-R interval between the first 2 beats in each group ( ie, the R-R interval between beats #2-3; 5-6; and 8-9 ) — as well as for the R-R interval between the last 2 beats in each group ( ie, the R-R interval between beats #3-4; 6-7; and #9-10 ) — as well as for duration of the R-R intervals of the short (..)

EKG/ECG 441

EKG/ECG Wellness 441

ETM Course

JULY 31, 2024

Also available on Apple Spotify YouTube iHeart Podchaser PlayerFM This was a really well designed and executed study, and the results will be practice changing for anyone who treats trauma patients.

Fractures 119

Fractures Wellness 119

Science Based Medicine

OCTOBER 11, 2024

It doesn't bode well for the future that "leaders" of major American institutions look at naked emperors and compliment them on their beautiful clothes. The post The President of Stanford Wants Us To Debate Which Number is Larger, 9 or 133 first appeared on Science-Based Medicine.

Wellness 126

Wellness 126

First 10 EM

MARCH 18, 2024

I guess it never felt necessary, as it was the first ever EMCrit post, and therefore felt well covered in the FOAMed community. Looking back, I am somewhat surprised I never published a First10 approach to sympathetic crashing pulmonary edema.

Wellness 129

Wellness EMS 129

The Trauma Pro

SEPTEMBER 27, 2024

Make sure the airway is well-placed and secure, or provide one now. Then apply a bulky and compressive dressing, and get out of the way so the EMS providers can do their thing. The aftermath. Once the patient has been extricated, double check the patient’s ABCs. Then get the patient to definitive care so the trauma team can get to work.

EMS 214

EMS Wellness 214

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. 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). You want to be a hospital CEO.

Wellness 144

Wellness Hospitals 144

The Trauma Pro

SEPTEMBER 1, 2023

But unless we have a discussion with the patient and their family well in advance, the opportunity will be missed and may result in unwanted and futile care. Other unpredictable events, like cardiac arrest or an issue severe enough to require unexpected ICU admission, may be even more predictive. Reference: Are we waiting for the sky to fall?

Hospitals 196

Hospitals Wellness 196

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

The Trauma Pro

SEPTEMBER 20, 2024

This is important for the well-being of the patient, the rescue crews, and the patient. If an in-house surgeon is not used, consideration must be given to the nearest safe landing zone, and this may mean that an out-of-house surgeon would have to travel to the hospital for pick-up.

Hospitals 177

Hospitals EMS Wellness 177

RebelEM

JUNE 29, 2023

REBEL Cast Ep119: A Discussion with Scott Weingart on the CT FIRST Trial Click here for Direct Download of the Podcast Timing Is 6hrs reasonable because most pts excluded because of this Right before heading up to ICU seems good 1st couple hours after ROSC…pts are high risk for re-coding Where Not single coverage or stand-alone EDs Optimize and transfer…scans (..)

CPR 144

CPR EMS Documentation/Coding Outcomes 144

Sensible Medicine

MARCH 12, 2024

On February 8th, Lisa Rosenbaum published an excellent and thought-provoking piece in the New England Journal titled: On Being Well While Doing Well — Distinguishing Necessary from Unnecessary Discomfort in Training. Yet, it seems that there is a palpable, unique shift in mindset amongst young medical trainees.

Wellness 134

Wellness Academics Research 134

EM Ottawa

APRIL 18, 2024

In this Prehospital Journal Club Recap, let us take a deep dive into the use of blood products, as well as the adjunct use of automated controlled elevation in CPR.

CPR 114

CPR Resuscitation Shock Wellness 114

Science Based Medicine

JANUARY 14, 2024

The latest report from the American Academy of Pediatrics is filled with misinformation and missing key articles that support the well-researched conclusion that there is no legitimate evidence of negative health effects of glyphosate.

Pediatrics 122

Pediatrics Research Wellness 122

The Trauma Pro

JUNE 14, 2024

The authors called out the usual culprits: Fluid between loops of bowel Active bleeding in the mesentery Bowel wall perfusion defects But they also noted that traumatic abdominal wall hernias were highly associated with seat belt sign as well. With newer scanners, radiologists are better able to detect subtle areas of hypoperfusion as well.

Operations 147

Operations Radiology Radiology Hospitals 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 139

Poisoning Airway Management Seizures Shock 139

The Trauma Pro

JUNE 6, 2023

It is essentially an elliptical sheet of muscle that is doubly curved, so it does not lend itself well to diagnosis by axial imaging. I will follow this up on Friday with an interesting delayed diaphragm injury case. Diaphragm injury is a troublesome one to diagnose.

Operations 259

Operations Wellness 259

Greater Sydney Area HEMS

SEPTEMBER 22, 2024

Together, we will discuss the experiences of clinicians involved in this trial, specifically highlighting the importance of maintaining good ALS prior to the arrival of, as well as during the presence of, the pre-care team as well as how the pre-care trial is impacting attitudes towards cardiac arrest management across the greater workforce.

Wellness 98

Wellness 98

Mount Sinai EM

JULY 27, 2023

Role of the spleen Red pulp: sinusoids filter out larger rigid particles including senescent and/or parasitized red blood cells, as well as unopsonized bacteria. This is specific but not sensitive.

Sepsis 182

Sepsis Wellness Infectious Diseases 182

Life in the Fast Lane

SEPTEMBER 11, 2024

one of the most difficult and risky emergency procedures, but one you already have the ultrasound and line skills to perform well. James Miers and John Mackenzie Procedure: Pericardiocentesis Emergency Procedure: Pericardiocentesis.

Ultrasounds 103

Ultrasounds Wellness 103

Sensible Medicine

JUNE 15, 2024

Being well versed in domains of history and sports may even have a greater impact in the clinic, as it allows you to bond with many patients. A greater focus on wellness or work-life balance will solve none of these concerns. This is a disservice to students even when they themselves demand that more activist faculty hold these roles.

Research 144

Research Wellness Academics Administration 144

The Trauma Pro

JANUARY 5, 2024

Bottom line: Well, this was a new one for me. Although still a relatively small and single-institution study, it was well done and could easily detect statistical significance. The only prior study I could find was published in 2022 by a group at the University of Nevada at Las Vegas.

Hospitals 133

Hospitals Wellness Outcomes 133

American Medical Compliance

SEPTEMBER 23, 2024

Caregiving is an inherently demanding profession, especially within assisted living facilities, where caregivers must balance the dual responsibilities of delivering high-quality care and managing their own emotional and physical well-being. Encourage Self-Care Practices Promote the importance of self-care among caregivers.

Wellness 105

Wellness Operations 105

Sensible Medicine

MAY 28, 2024

The adoption of depression screening is, of course, well-intentioned. The benefit of screening is just too small to be detected by well-designed trials. She is brilliant, well-read, and excels in school. Sensible Medicine is a reader-supported publication. If you appreciate our work, consider becoming a free or paid subscriber.

Military 144

Military Outcomes Psychiatric Wellness 144

Dr. Smith's ECG Blog

MAY 5, 2024

Leads I and aVL have hyperacute T waves as well. But they have an interest in ECGs, lots of exposure to OMI ECGs as well as normals and mimics, an interest in acute coronary occlusion, and a talent for seeing the subtle waveform findings of acute OMI. V1 has inappropriate ST elevation with a terminally negative T wave.

EKG/ECG 127

EKG/ECG Wellness 127

Sensible Medicine

APRIL 30, 2024

Dr. Zeraatkar is well-spoken, clear and she explains a complicated topic in simple terms. She often works in areas in which the evidence is complex or conflicting, examples of which include nutrition and COVID-19 therapeutics. For her research, in 2023, she was awarded a Gairdner Early Career Investigator Award. Stay for her final comment.

Research 126

Research Wellness 126