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. ECG 1 What do you think?

E-9-1-1 117

E-9-1-1 OR Coronary ACS 117

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

Don't Forget the Bubbles

JUNE 17, 2024

Introduction: Civility Matters Healthcare environments, particularly emergency departments, are characterised by high levels of Volatility, Uncertainty, Complexity, and Ambiguity ( VUCA ). Here are ten things to think about: 1. Churruca K, Pavithra A, McMullan R, Urwin R, Tippett S, Cunningham N, Loh E, Westbrook J.

E-9-1-1 105

E-9-1-1 Critical Care CPR ICU 105

Don't Forget the Bubbles

JUNE 30, 2023

He has already climbed Ben Nevis in Scotland, visited the Gobi desert (possibly from the comfort of his parents 4 x 4, but who’s judging) and has his bronze D of E nailed. She calls out her findings: A – OK B – 1 puncture mark to the anterior left chest wall, covered with a three-sided dressing. Actively oozing.

E-9-1-1 139

E-9-1-1 FFP Plasma Emergency Department 139

Don't Forget the Bubbles

JULY 17, 2023

You will find the list is broken down into four sections: 1.Reviews 2023 Jun 1. 2023 Jun 1;76(6):731-736 The Association Between Media-Based Exposure to Nonsuicidal Self-Injury and Emergency Department Visits for Self-Harm. 2023 Jun 9. 2023 Jun 6:1-11. 2023 Jun 9. Low yield from imaging after non -E.

E-9-1-1 98

E-9-1-1 ALS Emergency Department Emergency Medical Services 98

EMDocs

JUNE 7, 2023

1-5 Farmers also treat sheep for parasites using OPs and may become symptomatic after exposure, an illness called Dipper’s Flu. 8 Intermediate syndrome Occurs 1 to 5 days after acute exposure in up to 40% on individuals. 7, 9 Often have absence of excessive cholinergic stimulation. 7 May lead to respiratory failure.

E-9-1-1 83

E-9-1-1 ICU Emergency Department ED 83

Don't Forget the Bubbles

MAY 29, 2023

A study of teams over a 1-year period highlights that people witnessing incivility are also affected, which could lead to individuals feeling unsupported in their teams. 2021:36:1–2, NP448–NP473 Available at. Review of Cultivating Communities of Practice: A Guide to Managing Knowledge, by Wenger E, McDermott R, Snyder WM].

Critical Care 98

Critical Care E-9-1-1 Paramedicine Paramedicine 98

EMDocs

JUNE 27, 2024

Abdomen : ND, NT, no guarding or rebound MSK : Tenderness to palpation over L ribs 7-9 Derm : No rashes Imaging: Image 1: Case courtesy of Miriam Leiderer, Radiopaedia.org, rID: 81468 Chest radiograph (CXR) shows new left lower lobe opacity What’s most likely diagnosis? 2022 Jul 5;328(1):57-68. 2020 Feb 12;10(1):2470.

E-9-1-1 75

E-9-1-1 ICU ACS EMS 75

REBEL EM

FEBRUARY 5, 2024

Sites: Investigators recruited patients at 31 French emergency departments at university and nonuniversity hospitals Duration : June 1, 2009 to March 31, 2015. Recurrence of pneumothorax within 1 year. Pneumothorax recurrence within 1 year: 20% for aspirations, 27% for chest tubes. Panacek, E. Strange, C.,

E-9-1-1 105

E-9-1-1 ALS Emergency Department OR 105

EMDocs

SEPTEMBER 7, 2023

1 Clinical Questions: When should a clinician suspect diethylene glycol (DEG) toxicity? Toxicity typically evolves through three phases: 2,3,7,8,9 Phase 1: Gastrointestinal symptoms (e.g., 1 Of the 57 children, 96% had confirmed exposures to the acetaminophen-based teething medication.

E-9-1-1 65

E-9-1-1 ALS Emergency Department Plasma 65

NAEMSP

APRIL 19, 2023

However, evidence emerged in the 1980’s demonstrating that calcium chloride had no effect on return of spontaneous circulation (ROSC) rates, and in fact could be detrimental (Landry, Foran, & Koyfman, 2014). Current AHA guidelines do not recommend routine use of calcium in cardiac arrest (Panchal, et al.,

E-9-1-1 52

E-9-1-1 Advanced Life Support Overdose CPR 52

Dr. Smith's ECG Blog

APRIL 22, 2022

But these cases show the potential dangers of delayed recognition and treatment of inferior reperfusion Take away 1. ECG’s can be labeled as ‘normal’ by the computer (and confirmed by cardiology) even with diagnostic signs of occlusion or reperfusion References 1. Case Rep Emerg Med 2014 7. JAMA Intern Med 2019 9.

E-9-1-1 52

E-9-1-1 STEMI ALS ED 52

REBEL EM

DECEMBER 10, 2023

Background: The use of ultrasound is well established for trauma patients in the emergency department, with almost every patient receiving a FAST (Focused Assessment with Sonography in Trauma) examination as part of the “ABC’s” of trauma. 2022 Jan 1;92(1):44-48. 2015 Jan;39(1):172-8. Acad Emerg Med.

E-9-1-1 40

E-9-1-1 Emergency Department OR ALS 40

EMDocs

AUGUST 7, 2023

1 A D-dimer level can, therefore, be used as a non-specific and indirect biomarker for the presence of intravascular clotting, which may be useful in the diagnosis of VTE. 1-3 In this patient population, the NPV of a negative D-dimer level is high, such that a negative test makes further evaluation for VTE unnecessary.

E-9-1-1 69

E-9-1-1 ALS Plasma OR 69

Don't Forget the Bubbles

JANUARY 10, 2024

Let’s take the humble blood transfusion – used in emergency departments across the globe and playing a key role in critical care. The study asked TWO questions: 1. 3,950 children were recruited between September 2014 to May 2017. 8% die in hospital, with a further 12% dying in the six months following discharge.

E-9-1-1 78

E-9-1-1 ALS OR Critical Care 78

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 mg/kg Rocuronium versus 1 to 1.5 mg/kg Rocuronium versus 1 to 1.5 Ann Emerg Med. Updated 2021 Oct 1].

E-9-1-1 52

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

EMDocs

FEBRUARY 12, 2024

Introduction Arterial blood gas (ABG) or venous blood gas (VBG) testing is used to assess the pH and systemic carbon dioxide tension in patients, and, therefore, provide a more complete picture of their acid-base status than an isolated basic metabolic panel (BMP) (1). However, ABGs have many drawbacks compared to VBGs.

Emergency Department 94

Emergency Department E-9-1-1 ED ICU 94

Dr. Smith's ECG Blog

JANUARY 10, 2020

Here is the parasternal short axis, performed by a real expert in emergency department point of care cardiac ultrasound: There does not appear to be an anterior wall motion abnormality. I was relieved to see this MRI result: MRI IMPRESSION 1) Mildly decreased LV function with no focal wall motion abnormalities. Pericarditis?

E-9-1-1 52

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

REBEL EM

JULY 18, 2022

Am J Emerg Med. 2013 Sep;31(9):1389-92. The NoPAC trial, which was published in 2021,(1) compared TXA to placebo in a large multicenter randomized control trial in the UK which looked at data from 26 emergency departments. Ann Emerg Med. PMID: 33612282 Janapala RN, Tran QK, Patel J, Mehta E, Pourmand A.

E-9-1-1 52

E-9-1-1 Epinephrine ED ALS 52

Don't Forget the Bubbles

JULY 5, 2023

Figure 1: Clinical manifestations and long-term consequences of sickle cell disease Training and education on sickle cell disease: Training and education are crucial to improve morbidity and mortality. Investigations : Bloods show Hb of 8 g/L, White cell count 13x 10 9 /L, Platelets 570 x10 9 /L, CRP 35mg/L.

E-9-1-1 126

E-9-1-1 ACS OR ICU 126

Don't Forget the Bubbles

SEPTEMBER 18, 2023

This blog post aims to help familiarise you with some of the most common reasons for prescribing antibiotics in the paediatric emergency department. Antibiotic Use for Common Infections in Pediatric Emergency Departments: A Narrative Review. Addo-Yobo E, Chisaka N, Hassan M, Hibberd P, Lozano JM, Jeena P, et al.

Emergency Department 143

Emergency Department E-9-1-1 ALS OR 143

AAEM RSA

AUGUST 27, 2020

1 The primary goal of cardiopulmonary resuscitation (CPR) is to optimize coronary perfusion pressure and maintain systemic perfusion in order to prevent neurologic and other end-organ damage while working to achieve ROSC. Kirkegaard H, Soreide E, de Haas, I et al. De Fazio C, Skrifvars MB, Soreide E et al. 2019;23(1):1–9.

E-9-1-1 52

E-9-1-1 CPR ICU ALS 52

EM Didactic

DECEMBER 19, 2018

Introduction Pain is one the most common presentation to the emergency department (ED) and therefore, we should be aware of novel treatments options, adjuncts that can be used in addition to conventional therapies. Low-dose ketamine vs morphine for acute pain in the ED: a randomized controlled trial Am J Emerg Med.

E-9-1-1 40

E-9-1-1 Emergency Department ALS ED 40

REBEL EM

MAY 15, 2024

Comparison of the MASCC and CISNE scores for identifying low-risk neutropenic fever patients: analysis of data from three emergency departments of cancer centers in three continents. Neutropenic Fever: Fever (one reading of 38.3C Neutropenic Fever: Fever (one reading of 38.3C Support Care Cancer. 2018 May;26(5):1465-1470. Clarke, R.

E-9-1-1 105

E-9-1-1 OR Emergency Department ALS 105

ALiEM

OCTOBER 2, 2023

A 6-year-old male presented to the pediatric emergency department (PED) for scalp lesions. F) temporal; Resp 18; SpO2 99%, RA Skin : Large, 3 x 3cm indurated, erythematous lesion located over the patient’s right temporal scalp (Image 1). Minakova E, Doniger SJ. Pediatr Emerg Care. 2014 Jun;30(6):437-9.

E-9-1-1 189

E-9-1-1 Emergency Department OR 189

EMDocs

JULY 15, 2023

aureus (including MRSA), Klebsiella pneumoniae , influenzae , E. aureus (including MRSA), Klebsiella pneumoniae , influenzae , E. aureus (including MRSA), Klebsiella pneumoniae , influenzae , E. pneumoniae , S. pneumoniae , S. pneumoniae , S.

E-9-1-1 65

E-9-1-1 EMS OR ED 65

EMDocs

DECEMBER 18, 2023

This was based on studies that demonstrated qSOFA was more specific but less sensitive than its counterparts (Table 1). 1 Since 2021, attempts to identify a single screening tool with optimal sensitivity and specificity to predict which patients will develop sepsis or septic shock have been ongoing.

E-9-1-1 65

E-9-1-1 ALS Emergency Department Plasma 65

EMDocs

JANUARY 6, 2024

You review his chart and note that he had a heart transplant in 2014 but has not followed up with a cardiologist for at least 3 years. 1 There are over 50,000 visits related to heart transplant in the United States each year and over half of these patients are admitted to the hospital from the ED.

EMS 63

EMS E-9-1-1 ACS Coronary 63

ACEP Now

NOVEMBER 7, 2023

A 67-year-old man presents to the emergency department (ED) in cardiac arrest. Out-of-hospital cardiac arrest unfortunately occurs relatively commonly and emergency physicians must be equipped to diagnose and treat this rapidly. Heart disease and stroke statistics—2014 update: a report from the American Heart Association.

Defibrillator 52

Defibrillator E-9-1-1 ALS Epinephrine 52

EMDocs

MAY 29, 2023

Louis); Marina Boushra (EM-CCM, Cleveland Clinic Foundation); Brit Long, MD (@long_brit) Case A 54-year-old female with a past medical history of rheumatoid arthritis presents to the emergency department (ED) with generalized fatigue. ESR and CRP are widely used in monitoring and detecting multiple inflammatory conditions.

ED 53

ED E-9-1-1 Emergency Department OR 53

Don't Forget the Bubbles

SEPTEMBER 23, 2024

You are working in the paediatric emergency department of a busy District General Hospital. These centres have a close relationship with their patients, but this does not mean they may not turn up at your emergency department! Pediatric nephrology , 22 (9), pp.1243-1250. Pediatric Nephrology , 34 (1), pp.31-43.

E-9-1-1 52

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

EMDocs

NOVEMBER 4, 2024

1 The ED is a fast-paced environment where patient stability and life-and-limb-threatening conditions are prioritized. The American Academy of Emergency Medicine has called effective, efficient, and safe pain management a “specialty-defining skill.” Opioid analgesia is appropriate for moderate to severe acute abdominal pain (Table 1).

ED 98

ED E-9-1-1 Emergency Department ALS 98

EMDocs

NOVEMBER 13, 2023

The use of CTA (computed tomography angiography) in the emergency department (ED) has increased dramatically in the past 20 years. 1 One study found that CTA head and neck was ordered for 2.5% 8 The VAN (vision, aphasia, neglect) score ( Figure 1 ), first proposed by Teleb et al. of patients with blunt multisystem trauma.

E-9-1-1 86

E-9-1-1 ALS Emergency Department ED 86

REBEL EM

NOVEMBER 11, 2024

What They Did: Investigators performed a retrospective cohort study in the Emergency Department at the University of Michigan between July 1, 2014 through December 31, 2018. Comorbidity Index : Higher in the cefepime group (median 2 vs. 1). 9 Instrumental Variable Analysis? vs. 52.2%). vs. 15.3%).

E-9-1-1 84

E-9-1-1 ALS ICU Critical Care 84