Dr. Smith's ECG Blog

DECEMBER 27, 2023

Written by Willy Frick A man in his 50s with a history of hypertension, dyslipidemia, type 2 diabetes mellitus, and prior inferior OMI status post DES to his proximal RCA 3 years prior presented to the emergency department at around 3 AM complaining of chest pain onset around 9 PM the evening prior. Tikkanen, J. Wellens, H., &

E-9-1-1 116

E-9-1-1 OR Coronary ACS 116

Pediatric EM Morsels

OCTOBER 27, 2023

Rosenburg 2010] B-L system is designed for 12yo and younger, patients up to 80 lbs, height 46-143 cm [Meguerdichian 2012] Estimates the 50%ile weight for height (Length vs Ideal Body Weight). Sinha 2012] It is useful in the prehospital setting , correlating well with actual weight and ED Broselow weight. Recommended by ATLS and PALS.

E-9-1-1 269

E-9-1-1 Emergency Medical Services Life Support ALS 269

Don't Forget the Bubbles

NOVEMBER 29, 2023

You are the Paediatric doctor on call and receive a call for an incoming patient to the emergency department. Tragically, several attempts at resuscitation upon arrival at the emergency department were unsuccessful. A 12-year-old male is being transported by ambulance after a road traffic accident. His name is Ben.

E-9-1-1 135

E-9-1-1 Emergency Department ED CPR 135

Don't Forget the Bubbles

SEPTEMBER 30, 2024

In the UK, as in most developed countries, more patients are presenting to Emergency Departments (EDs) with minor illnesses or injuries. Emergency department overcrowding is a complex issue with multiple contributing factors. A 2011-2012 Australian study by Blake et al. Simpson et al. Simpson et al.

Emergency Department 89

Emergency Department ALS ED OR 89

The Skeptics' Guide to EM

APRIL 8, 2023

John Brown PhD is a Professor of Health Services Research in Ireland who has been studying rural healthcare issues since 2012. There have been many “temporary” rural emergency department closures during the past last year. It was a stepped-wedge reconfiguration of the entire Danish emergency healthcare system.

Emergency Department 139

Emergency Department ED Ambulance ALS 139

Pediatric EM Morsels

JULY 19, 2024

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. If bleeding, the only lab that is needed in the Emergency Department is a type and cross. Get IV access!

E-9-1-1 286

E-9-1-1 Epinephrine Emergency Department OR 286

REBEL EM

SEPTEMBER 13, 2023

patients that take ACE inhibitors (but 20-30% of all angioedema presentations to the Emergency Department) 3 times more common in Black Americans ( Kostis 2005 ) 0.01 patients that take ACE inhibitors (but 20-30% of all angioedema presentations to the Emergency Department) 3 times more common in Black Americans ( Kostis 2005 ) 0.01

Frozen Plasma 105

Frozen Plasma Allergic Reaction FFP Plasma 105

EMDocs

AUGUST 22, 2024

12 How do we address these disparities in the emergency department? You may be more familiar with the term “limited English proficiency” (LEP), defined as: someone who does not speak English as their primary language and has a limited ability to read, speak, write, or understand English.

Emergency Department 81

Emergency Department ALS E-9-1-1 ED 81

Don't Forget the Bubbles

AUGUST 23, 2023

In most Emergency Departments, staff are allotted little of that scarce resource, time, to begin processing what has just occurred. The Pause Jonathon Bartels worked as an Emergency Nurse in America in 2009. After the death of a young person in the Emergency Department, he initiated ‘ The Pause.’ Cunningham T.

Emergency Department 98

Emergency Department ICU ALS Critical Care 98

ALiEM

DECEMBER 4, 2023

A 49-year-old male presented to the emergency department of an academic hospital with the chief concern of penile pain. Calciphylaxis: a systematic review of existing and emerging therapies. He then noticed the pain start and grow in intensity without radiating anywhere else except the glans. There is no crepitus or swelling.

Emergency Department 152

Emergency Department OR 152

The Skeptics' Guide to EM

JANUARY 14, 2018

Effectiveness of intravenous lidocaine versus intravenous morphine for patients with renal colic in the emergency department. Urology 2012 Guest Skeptics: Dr. Tony Seupaul is the Chairman of the Department of Emergency Medicine at the University of Arkansas. A study from Bindman et al. A study from Bindman et al.

Emergency Department 130

Emergency Department ALS ED OR 130

REBEL EM

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 (..)

E-9-1-1 59

E-9-1-1 ACS OR Emergency Department 59

ALiEM

MAY 19, 2023

A heavy alcohol drinker, who is well known to your Emergency Department, presents with altered mental status, except that he looks different this time. In our emergency department, the RTs do not spend a lot of time going around measuring cuff pressures and usually save that until the patient reaches the ICU.

E-9-1-1 245

E-9-1-1 Emergency Department ICU OR 245

ALiEM

OCTOBER 20, 2023

A 50-year-old Caucasian female with a history of hypertension, coronary artery disease, and insulin-dependent diabetes mellitus presents to the emergency department with a complaint of painful sores on the top of her left foot. 2012 Jul;16(4):614-20. Available from: [link] PMID:29083569. Indian J Endocrinol Metab.

Plasma 161

Plasma Coronary Emergency Department OR 161

The Skeptics' Guide to EM

AUGUST 5, 2023

Computerized tomography (CT) is commonly used in the emergency department in the diagnosis of TBI. Population: Children less than 18 years of age presenting with head injury to a level 2 pediatric trauma center in the United States between 2012-2013.

ALS 100

ALS Emergency Department OR 100

The Skeptics' Guide to EM

DECEMBER 17, 2022

Kirsty Challen is a Consultant in Emergency Medicine at Lancashire Teaching Hospitals. Case: A 71-year-old man is brought to your emergency department (ED) by emergency medical serviced (EMS) having fallen two steps at home. years ( 2 ).

Frozen Plasma 130

Frozen Plasma FFP Emergency Medical Services Plasma 130

The Skeptics' Guide to EM

SEPTEMBER 25, 2021

Most emergency department patients meeting sepsis criteria are not diagnosed with sepsis at discharge. Guest Skeptic: Dr. Jess Monas is a Consultant in the Department of Emergency Medicine at the Mayo Clinic Hospital, Phoenix, Arizona. Background: We have covered sepsis many times on the SGEM since 2012.

EMR 100

EMR Emergency Department ICU ALS 100

The Skeptics' Guide to EM

OCTOBER 3, 2020

Date: October 2nd, 2020 Guest Skeptic: Dr.Barbra Backus is an emergency physician at the Emergency Department of the Erasmus University Medical Center in Rotterdam, the Netherlands. She is the creator of the HEART Score and an enthusiastic researcher. Reference: Claiborne Johnston S et al. Reference: Claiborne Johnston S et al.

Emergency Department 100

Emergency Department ALS OR 100

Core EM

JULY 23, 2024

Author: Mallika Singh, MD Editor: Jonathan Kobles, MD Background Unintentional or intentional exposure to radiological material represents a potential threat to human health on the individual to mass-casualty scale. Radioactive sources include medical isotopes, fuel rods, generators, and other industrial sources. 10-Hour Flight: 0.03

ALS 130

ALS OR Emergency Department ED 130

Don't Forget the Bubbles

OCTOBER 10, 2024

Exploring communication preferences and risk thresholds of clinicians and parents of febrile infants under 90 days presenting to the emergency department: a qualitative study. John has organised the reviews and an ongoing partnership between BRCH and Bubble Wrap is planned :). 2023 Mar 30;110(4):432-438. Arch Dis Child.

ED 75

ED Emergency Department OR ALS 75

Don't Forget the Bubbles

NOVEMBER 8, 2023

7-year-old Tilly is brought to your emergency department at 11 p.m. Abdominal pain in children is common, accounting for over 1 in 20 attendances to paediatric emergency departments [1]. by her father. She has had abdominal pain for two days, and it has now moved to the right side. She is obviously uncomfortable.

Emergency Department 105

Emergency Department ALS OR Ambulance 105

The Skeptics' Guide to EM

DECEMBER 12, 2020

Case: A 52-year-old previously healthy woman presents to your emergency department (ED) with an abscess on her left forearm. Way back in 2012 we looked at packing after incision and drainage (I&D) on SGEM#13 and concluded routine packing might not be necessary. One issue that has not been covered yet is the loop technique.

ALS 130

ALS ED Emergency Department OR 130

REBEL EM

APRIL 29, 2024

Over the years emergency and critical care physicians have tried many ways to establish IV access in emergencies including the “crash” or “dirty” central line. The IO can actually be your “GO-TO” emergency line or your second choice after failed PIV access.

ALS 105

ALS Epinephrine Critical Care Emergency Department 105

ACEP Now

FEBRUARY 13, 2024

A 77-year-old man presented to the emergency department (ED) with hip pain following a fall. 1–4 Emergency physicians commonly prescribe opioid pain medications, and there is significant variability among prescribing patterns. In the January issue of Annals of Emergency Medicine , Merz-Herrara, et al., 2016;129(2):221.e21–221.e30.

E-9-1-1 52

E-9-1-1 Emergency Department ED ALS 52

EMDocs

DECEMBER 11, 2023

Traditionally, emergency providers looked for signs of ST-segment elevation myocardial infarction (STEMI) to indicate the need for intervention. In October 2022, the American College of Cardiology released an updated expert consensus decision regarding the evaluation of chest pain in the emergency department.

STEMI 109

STEMI Coronary Emergency Department OR 109

The Skeptics' Guide to EM

JANUARY 7, 2018

Chris Carpenter is from Washington University, Deputy Editor of Academic Emergency Medicine and faculty member of Emergency Medicine and Critical Care course. Case: A 35-year-old female presents to your emergency department three-hours after the onset of a severe frontal headache. Your physical exam is normal.

Emergency Department 100

Emergency Department Critical Care ALS OR 100

FOAMfrat

JULY 1, 2023

titled "The Association of Rocuronium Dosing and First-Attempt Intubation Success in Adult Emergency Department Patients" revealed that first-attempt intubation success was the highest when more than 1.4 Their recommendation, as I can tell, appears to come from two things: A paper by Levin NM et al. mg/kg of Rocuronium was used [4].

E-9-1-1 52

E-9-1-1 Emergency Department OR ALS 52

Core EM

MARCH 12, 2024

Author: Mallika Singh, MD Editor: Jonathan Kobles, MD Background Unintentional or intentional exposure to radiological material represents a potential threat to human health on the individual to mass-casualty scale. Radioactive sources include medical isotopes, fuel rods, generators, and other industrial sources. 10-Hour Flight: 0.03

ALS 130

ALS OR Emergency Department ED 130

The Skeptics' Guide to EM

SEPTEMBER 30, 2017

Emlyn’s blog and podcast since 2012. Case: You are working the afternoon shift in the paediatric emergency department. Your shift is almost over and the department finally seems to be under control. She is a medical education enthusiast and has been an editor and regular contributor to the St.

Emergency Department 130

Emergency Department ALS OR 130

The Skeptics' Guide to EM

MARCH 6, 2021

Background: Epistaxis is a common Emergency Department (ED) complaint with over 450,000 visits per year and a lifetime incidence of 60% ( Gifford 2008 , Pallin 2005 ). The episode included the Dundee protocol for adult epistaxis management from 2012. You apply direct pressure for 10 minutes, but the bleeding continues.

ALS 130

ALS Emergency Department EMS ED 130

EMDocs

MAY 26, 2023

But what about the patient who is agitated, and is a potential danger to themselves or to the ED staff? Do we Redirect? Patient that are agitated should always be treated with dignity and respect. This entails utilizing the least invasive non-pharmacologic means of assisting them, before moving to physical or chemical restraints.

Emergency Medical Services 75

Emergency Medical Services Emergency Department OR ED 75

FOAMfrat

MAY 19, 2024

While transporting to the emergency department, the patient’s mother informed me that PDCD affects less than 1 in 50,000 individuals and is more common in males than females. Upon arrival in the pediatric emergency department, the patient was conscious and alert to her normal mental status, which included being nonverbal.

E-9-1-1 97

E-9-1-1 ALS Emergency Department EMT 97

REBEL EM

MARCH 8, 2023

Rapid diagnosis and emergency referral improves outcomes of ophthalmologic interventions. Emergency Department Management: Emergency ophthalmology consultation. Emergency surgical management indicated if concomitant retinal tear, vitreous hemorrhage, or retinal detachment. >10 floaters, (+) LR 8.1-36

Emergency Department 52

Emergency Department ALS ED OR 52

REBEL EM

AUGUST 30, 2023

REBEL Core Cast 107.0 – Vertebral Osteomyelitis Click here for Direct Download of the Podcast Definition Inflammation of the vertebrae due to a pyogenic, fungal or mycobacterial organism. Classified as either acute (days), subacute (weeks) or chronic (months) Spondylodiscitis: a term encompassing osteomyelitis, spondylitis and discitis.

E-9-1-1 104

E-9-1-1 ALS ED OR 104

Don't Forget the Bubbles

JANUARY 17, 2024

Curious Ken is brought into your emergency department. Mirza and Sheikh reported perhaps the first unfortunate case in 2012. In 2012, one brand of SAP beads – Water Balz – was recalled by the U.S. 2012 Jan;3(1):6. His older brother, Roy, had found him playing with his toys, and an argument ensued.

E-9-1-1 111

E-9-1-1 ALS Emergency Department OR 111

The Skeptics' Guide to EM

MARCH 10, 2018

The American College of Chest Physicians published some evidence-based recommendations in 2012 on anticoagulation therapy [1]. We will summarize some of the recommendations for emergent anticoagulation reversal in the emergency department in the show notes. We will put a link in the show notes to the protocol.

Emergency Department 100

Emergency Department ALS Coronary OR 100

ACEP Now

SEPTEMBER 11, 2023

5 Pediatric discharges were reported by 2,784 hospitals in 2000 and the number of reporting hospitals increased to 4,179 in 2012. From these data, the authors looked at five reporting periods—2000, 2003, 2006, 2009, and 2012—and identified ARF case incidences of 0.63, 0.77, 0.64, 0.51, and 0.52, respectively, per 100,000 children.

ALS 52

ALS Emergency Department OR 52