Pediatric EM Morsels

JULY 19, 2024

DON’T forget to put on your Personal Protective Equipment as well! Have traditional, direct laryngoscopes available as well. This is worth a shot in a well appearing child that is old enough to gargle and spit. Well… sometimes it starts again. Get good light and exposure! Headlamps can also be helpful!

Airway Management 286

Airway Management Pediatrics Wellness Operations 286

The Trauma Pro

SEPTEMBER 6, 2024

I’ve included a printable pdf file, as well as the original Microsoft Publisher file in case you want to make a few modifications to suit your own hospital. There is also an indication of what you need to do, and exactly when to call your consultant. Here’s a reference sheet formatted at a 3×5 index card that you can keep in your pocket.

Operations 264

Operations Hospitals Wellness 264

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

Pediatric EM Morsels

OCTOBER 27, 2023

Taking care of a critically ill child can be nerve-racking to say the least, and downright petrifying for those who don’t do it frequently, even if they are well-trained and brilliant clinicians. Sinha 2012] It is useful in the prehospital setting , correlating well with actual weight and ED Broselow weight. Broselow does not.

Pediatrics 269

Pediatrics Resuscitation Documentation/Coding Wellness 269

Ken Grauer, MD

AUGUST 16, 2024

See ECG Blog #435 — 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 ). Acute PE remains one of the most commonly overlooked diagnoses. As per links that I provide below — IF the diagnosis of acute PE is not thought of, this entity will be missed! (

EKG/ECG 391

EKG/ECG Wellness Shock 391

Ken Grauer, MD

JUNE 7, 2024

Improvement of symptoms that correlates with improvement in ECG findings does not mean "all is well". ECG Blog #193 — Reviews the basics for predicting the " culprit " artery ( as well as reviewing why the term "STEMI" — should be replaced by "OMI" = O cclusion-based MI ). Figure-2: I've labeled the initial ECG in today's case.

EKG/ECG 339

EKG/ECG Wellness 339

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 199

Airway Management Operations Hospitals Wellness 199

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

Pediatric EM Morsels

JANUARY 19, 2024

Unfortunately, the possibility of congenital infections always looms large as well, including congenital syphilis. We have previously touched on congenital issues like Congenital Adrenal Hyperplasia , Congenital Pulmonary Airway Malformation , Neonatal Leukemia , and of course there is always the Inconsolable Infant.

Infectious Diseases 269

Infectious Diseases CDC Pediatrics Fractures 269

Ken Grauer, MD

AUGUST 8, 2024

But, given my heightened clinical suspicion — there is no denying ST segment straightening in leads I and aVL , as well as in the inferior leads. ECG Blog #193 — Reviews the basics for predicting the " culprit " artery ( as well as reviewing why the term "STEMI" — should be replaced by "OMI" = O cclusion-based MI ).

EKG/ECG 316

EKG/ECG Resuscitation Wellness 316

Ken Grauer, MD

MARCH 1, 2024

No clear history for recent chest pain — but the patient "has not been well" for the previous week. 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".

EKG/ECG 494

EKG/ECG EMS Wellness 494

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

Ken Grauer, MD

DECEMBER 1, 2023

This blog post reviews the basics for predicting the " C ulprit" A rtery ( as well as reviewing why the term "STEMI" — should replaced by " OMI" = O cclusion-based MI ). ECG Blog #193 — illustrates use of the M irror T est to facilitate recognition of acute Posterior MI.

EKG/ECG 414

EKG/ECG EMS Wellness 414

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 202

Radiology Radiology Operations Resuscitation 202

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 245

Wellness 245

Ken Grauer, MD

JUNE 26, 2023

That said — since today’s patient is a “young man” — and the rate of today’s rhythm is extremely fast ( ie, 250-260/minute — which is faster than is usually seen in a VT rhythm that maintains a well-defined QRS morphology ) — we clearly can not discount the possibility of an SVT rhythm.

EKG/ECG 366

EKG/ECG Wellness 366

Pediatric EM Morsels

JUNE 7, 2024

For children at least 4 years of age who are not well controlled on ICS alone. Lucky for us, in 2020 there were some updates made to the NIH Asthma Management Guidelines and we’re going to discuss which ones can help us in the Emergency Department!

Pediatrics 206

Pediatrics Emergency Department Wellness EMS 206

Ken Grauer, MD

NOVEMBER 4, 2023

Instead — rate control of this patient's AFib, as well as confirmation of this rhythm diagnosis was obtained by treatment with a ß-blocker. Figure-4: Repeat ECG after IV and PO Metoprolol. Would A denosine have Worked for Today's Rhythm? Adenosine was not used in today's case.

EKG/ECG 419

EKG/ECG Wellness 419

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

Ken Grauer, MD

MAY 16, 2024

ECG Blog #193 — Reviews the basics for predicting the " culprit " artery ( as well as reviewing why the term "STEMI" — should be replaced by "OMI" = O cclusion-based MI ). R elated E CG B log P osts to Today’s Case : ECG Blog #205 — Reviews my S ystematic A pproach to 12-lead ECG Interpretation.

EKG/ECG 402

EKG/ECG Wellness 402

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

Ken Grauer, MD

MARCH 15, 2024

By the P s, Q s, 3 R Approach ( which I review in ECG Blog #185 ): Lots of P waves are present — being well seen in the long lead II rhythm strip. MY Approach to Today’s Tracing: As always — I favor beginning assessment with a quick look at the long lead rhythm strips at the bottom of the tracing. The Q RS complex is narrow in all 12 leads.

EKG/ECG 400

EKG/ECG Wellness 400

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

Ken Grauer, MD

APRIL 26, 2024

ECG Blog #193 — Reviews the basics for predicting the " culprit " artery ( as well as reviewing why the term "STEMI" — should be replaced by "OMI" = O cclusion-based MI ). . = R elated E CG B log P osts to Today’s Case : ECG Blog #205 — Reviews my S ystematic A pproach to 12-lead ECG Interpretation.

EKG/ECG 392

EKG/ECG Resuscitation EMS Wellness 392

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 126

Wellness EMS 126

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

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 140

Poisoning Airway Management Seizures Shock 140

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 187

Hospitals EMS Wellness 187

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 198

Hospitals Wellness 198

Ken Grauer, MD

APRIL 20, 2024

ECG Blog #193 — Reviews the basics for predicting the " culprit " artery ( as well as reviewing why the term "STEMI" — should be replaced by "OMI" = O cclusion-based MI ). . = R elated E CG B log P osts to Today’s Case : ECG Blog #205 — Reviews my S ystematic A pproach to 12-lead ECG Interpretation.

EKG/ECG 428

EKG/ECG Wellness 428

Ken Grauer, MD

JULY 29, 2023

This young woman did well for a year — but unfortunately suffered another cardiac arrest, from which she could not be resuscitated. Epsilon waves are best seen in leads V1 , V2 — and a bit less well seen in V3,V4. MRI confirmed ARVC. About A RVC/ A RVD. ARVD is a genetic disorder of the myocardium.

EKG/ECG 370

EKG/ECG Resuscitation Documentation/Coding Hospitals 370

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