Dr. Smith's ECG Blog

DECEMBER 27, 2023

The note also says "slight lateral ST elevations noted, likely early repolarization since unchanged compared to 2014." (This patient was not one of the lucky 6.4% of patients taken for immediate heart catheterization due to uncontrolled chest pain [Lupu].) V2 has some changes, but at least to me it is not as clear what to make of them.

E-9-1-1 118

E-9-1-1 OR Coronary ACS 118

The Skeptics' Guide to EM

APRIL 20, 2024

A clinical decision tool called the STUMBL score was derived and validated by Battle et al in 2014 [3]. With the 2014 CDC declaration that prescription drug overdose is one of the five top health threats, there has been a movement away from opioids as the mainstay of pain management for rib fractures [6].

Emergency Department 207

Emergency Department Overdose ALS ED 207

Pediatric EM Morsels

FEBRUARY 2, 2024

Travel dates can help to exclude certain infections by their incubation periods (Abdel-Haq 2021) Physical examination can sometimes reveal concerning features including hepatomegaly , jaundice or a rash that may guide differential. However, the destination of travel is also important as helminths have distinct geographical distribution.

E-9-1-1 161

E-9-1-1 ED OR Emergency Department 161

EMergucate

FEBRUARY 21, 2014

This week’s ECG is from a 62 yr old male who presented complaining of palpitations for the preceding 4 hours. No significant medical history or medications. See the ECG at: ECG of the Week &#…

OR 100

OR EMS 100

The Skeptics' Guide to EM

NOVEMBER 11, 2023

One of the best systematic reviews and meta-analyses on the topic discussing the diagnostic accuracy of the history, physical examination and imaging is by Carpenter et al from AEM 2014 [1]. DISCLAIMER: THE VIEWS AND OPINIONS OF THIS BLOG AND PODCAST DO NOT REPRESENT THE UNITED STATES GOVERNMENT OR THE US MILITARY.

ALS 241

ALS Emergency Department ED OR 241

The Skeptics' Guide to EM

OCTOBER 14, 2023

Background: We have looked at pediatric vital signs on the SGEM back in 2014 with PedEM superhero Dr. Anthony Crocco ( SGEM#98 ). It seems awfully high. We have been reading online about something called sepsis that can be deadly. Does he have sepsis?”

Life Support 218

Life Support Advanced Life Support Emergency Department ALS 218

Pediatric EM Morsels

JUNE 16, 2023

Shen 2013, Nickerson 2014, Scolaro 2016 ] Singh et al proposed an algorithm to guide treatment. Shen 2013, Nickerson 2014, Scolaro 2016 ] Singh et al proposed an algorithm to guide treatment. Shen 2013, Nickerson 2014, Scolaro 2016 ] Singh et al proposed an algorithm to guide treatment.

Overdose 152

Overdose OR Critical Care ALS 152

Don't Forget the Bubbles

NOVEMBER 29, 2023

2014 May;32(5):452-6. Epub 2014 Jan 15. Awake fiberoptic intubation where the patient consents, co-operative AND the airway is prepared with local anaesthesia. What are the potential physiological sequelae? Regardless of the age, awake intubations can lead to tachycardia or bradycardia, raised blood pressure and low oxygen saturation.

E-9-1-1 135

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

Pediatric EM Morsels

AUGUST 18, 2023

Rose 2014) They are the most frequently prescribed class of medications in adults; however, in children they are the least frequently prescribed class , <2% of antibiotics. Hersh 2014) Another study looked at all MAEs in juvenile beagles given either low dose or high dose fluoroquinolone. Which is a risk of 1 event for 62.5

E-9-1-1 130

E-9-1-1 ACS OR ALS 130

The Skeptics' Guide to EM

JUNE 17, 2023

The National Heart, Lung, and Blood Institute (NHLBI) released an expert panel report in 2014 with evidence-based guidelines for management of sickle cell disease recommending timely administration of parenteral opioids for VOE. [7] He denies any fever or difficulty breathing. The rest of his exam is unremarkable.

Emergency Department 182

Emergency Department ALS ED OR 182

Emergency Medicine Cases

FEBRUARY 11, 2020

Although the mortality rate in patients with Coronavirus in this outbreak is less than 1% (which pales in comparison to Ebola or SARS), historically these types of outbreaks have occured every 5-6 years (SARS 2003, HINI 2009, Ebola 2014, Coronavirus 2020), so they are somewhat predictable and we should know how to prepare for them in our EDs.

ED 130

ED EMS OR 130

ALiEM

AUGUST 30, 2024

2014 Dec;24(12):1670-751. The patient had no significant past medical history. She also endorsed three weeks of cough and congestion, and one day of muffled voice. She denied difficulty swallowing, fatigue, cold intolerance, or hair and nail changes. Physical Exam Vitals : BP 87/62; Pulse 80; Temp 36°C (96.8°F); Abdominal : Soft.

ACS 161

ACS Emergency Department ED OR 161

Emergency Medicine Cases

APRIL 12, 2017

In 2014, the CDC reported that UTI antibiotic treatment was avoidable at least 39% of the time. Over-diagnosis and treatment results from the fact that asymptomatic bacteriuria is very common in all age groups, urine cultures are frequently ordered without an appropriate indication, and urinalysis results are often misinterpreted. Their exam?

OR 130

OR EMS 130

ALiEM

SEPTEMBER 27, 2023

Disulfiram-like reaction with ethanol consumption Coprinus atramentarius or Ink Cap mushroom is well known to cause a disulfiram-like reaction when it is consumed prior to ethanol. This results in significant nausea and vomiting and can lead to tachycardia and hypotension. The post was peer reviewed on behalf of ACMT by Drs. Mushrooms, Coprine.

ALS 169

ALS OR ED 169

ALiEM

NOVEMBER 10, 2023

2014 Nov;107(11):724-7. Management of FDE anchors on identification and discontinuation of the causative agent. Topical or systemic steroids are common adjuncts and there is limited evidence suggesting the utility of systemic cyclosporine for severe cases [1]. Medicina (Kaunas). 2021 Sep 1;57(9):925. doi: 10.3390/medicina57090925.

Emergency Department 161

Emergency Department OR 161

The Skeptics' Guide to EM

MAY 14, 2022

These include: acetaminophen ( Williams et al Lancet 2014), steroids ( Balakrishnamoorthy et al Emerg Med J 2014) and benzodiazepines ( Friedman et al Ann Emerg Med 2017). The pain is 10/10 in intensity, gets worse with bending, turning, and prolonged walking. A heating pad and acetaminophen has not helped with the pain.

ALS 130

ALS Emergency Department ED OR 130

ALiEM

NOVEMBER 1, 2023

Intensive Care Med 2014; 40(1):104. PMID As ferrioxamine is excreted, the patient’s urine becomes an orange or brown rusty hue, classically referred to as vin rosé urine [1,2]. For iron toxicity, what are the indications for deferoxamine? 1, 3, 5] Vin rosé urine is simply indicates the excretion of ferrioxamine and is not harmful.

E-9-1-1 161

E-9-1-1 ALS OR ED 161

The Skeptics' Guide to EM

AUGUST 5, 2023

Annals of Emergency Medicine 2014. Annals of Emergency Medicine 2014. Annals of Emergency Medicine 2014. Reference: Easter JS et al. Comparison of PECARN, CATCH, and CHALICE rules for children with minor head injury: a prospective cohort study. Reference: Easter JS et al. So, should we CT scan children with minor head injury?

ALS 100

ALS Emergency Department OR 100

REBEL EM

JANUARY 9, 2024

This finding persists when looking at a number of other infections including skin and soft tissue infections (SSTI) ( First10EM ), pyelonephritis ( Strohmeier 2014 ) and even bone and joint infections ( Li 2019 ). This feels intuitive as the IV route seems like it would be stronger, faster, and fix the patient better than the oral route.

ALS 100

ALS ICU ED OR 100

ALiEM

MARCH 7, 2024

The pain is intermittent, sharp, severe, and associated with 2 episodes of nonbloody, nonbilious emesis. Her mother denies any fevers, upper respiratory symptoms, sore throat, or diarrhea. She adds that her daughter has complained of 2-3 episodes of dysuria and gross hematuria over the last few days. Lay the patient supine when possible.

E-9-1-1 177

E-9-1-1 Emergency Department ALS ED 177

ALiEM

SEPTEMBER 11, 2023

Contact Lens Wearer Demographics and Risk Behaviors for Contact Lens-Related Eye Infections–United States, 2014. She removed the contacts five hours later at 23:00, at which time she noted her eyes to feel drier than normal but did not note significant pain with removal, significant trauma, or a partial contact removal.

Emergency Department 152

Emergency Department ED OR 152

The Skeptics' Guide to EM

FEBRUARY 26, 2022

ED visits in the US for mental health conditions has increased by 44% from 2006 to 2014. This was based upon his article published in the Canadian Medical Association Journal ( CMAJ ). We also had Dr. Tyler Black on that episode to provide his expertise as a suicidologist.

ED 130

ED ALS Emergency Department OR 130

Pediatric EM Morsels

MAY 12, 2023

doi: 10.1136/archdischild-2014-307119. 2014 Jan 25;383(9914):308. PECARN is highly sensitive for identifying those with clinically important TBI. of these had a CT performed 1 (0.2%) had a clinically important TBI (ciTBI) 10 (5.1%) had any TBI on CT 9 (4.6%) had skull fractures Remember to always watch out for NAT ! Arch Dis Child.

OR 130

OR EMS 130

This Podcast Will Kill You

JULY 23, 2024

2014): 6-7. ” Internal and emergency medicine 9 (2014): 249-256. 2014): 19-36. CW: discussion of disordered eating, eating disorders Did the word gluten manifest in everyone’s consciousness one day in 2010? Suddenly, grocery stores were filled with gluten-free crackers, cookies, buns, you name it. Tune in today!

E-9-1-1 98

E-9-1-1 ALS OR 98

REBEL EM

DECEMBER 5, 2023

up to 23% ( Lieberman 2005 , Rohacek 2014 , Tole 2007 , Grunau 2014 ). Since half of biphasic reactions occur within the first 6-12 hrs ( Lee 2014 ) physicians often choose an observation time of 4-6 hrs. Biphasic anaphylactic reactions: occurrence and mortality Allergy 2014 Jun;69(6):791-7 Tole JW, Lieberman P.

Epinephrine 81

Epinephrine Allergic Reaction Emergency Department Emergency Management 81

REBEL EM

FEBRUARY 29, 2024

Background: Ventilator-associated pneumonia (VAP), or what the CDC recently renamed infection-related ventilator-associated complication (IVAC), is defined as a nosocomial pneumonia occurring on day 3 of mechanical ventilation that was preceded by 2 days of stable or decreasing ventilator requirements. 4, 8 Paper: Dahyot-Fizelier, C.,

E-9-1-1 126

E-9-1-1 ICU OR ALS 126

The Skeptics' Guide to EM

SEPTEMBER 12, 2020

Changes in Burnout and Satisfaction With Work-Life Balance in Physicians and the General US Working Population Between 2011 and 2014. He defined it as “a state of fatigue or frustration that resulted from professional relationships that failed to produce the expected rewards”. Shanafelt et al. Mayo Clin Proc 2015 * Shanafelt et al.

Emergency Department 130

Emergency Department ALS OR 130

The Skeptics' Guide to EM

SEPTEMBER 14, 2019

million emergency department visits in the US in 2014 [1], with the most significant proportion of visits occurring in the elderly ≥75 (1,682/100,000) [1]. He is not on anticoagulation and there is no history of seizures. Background: Head trauma is an exceedingly common presenting complaint in the emergency department, with approximately 2.5

Emergency Department 130

Emergency Department ALS EMS OR 130

The Skeptics' Guide to EM

SEPTEMBER 10, 2017

Acetaminophen Williams et al (Lancet 2014) * Muscle relaxants Friedman et al (JAMA 2015) * NSAIDs Machado et al (Ann Rheum Dis 2017) * Benzodiazepines Friedman et al (Ann Emerg Med 2017) Opioids are very effective at reducing pain. Low back pain is an extremely common presentation to US Emergency Departments representing 2.4%

Emergency Department 130

Emergency Department ALS OR 130

The Skeptics' Guide to EM

JANUARY 14, 2018

One issue that has been to use CT or ultrasound for the diagnosis. A study from Bindman et al. We learned recently about the ceiling effect of ketorolac for treating moderate to severe pain in the emergency department from Sergey Motov ( @PainFreeED ). He showed that 10mg IV ketorolac was just as effective as 15mg IV or 30mg IV.

Emergency Department 130

Emergency Department ALS ED OR 130

The Skeptics' Guide to EM

OCTOBER 10, 2020

These include: acetaminophen ( Williams et al Lancet 2014), muscle relaxants ( Friedman et al JAMA 2015), NSAIDs ( Machado et al

Emergency Department 130

Emergency Department ALS ED OR 130

The Skeptics' Guide to EM

NOVEMBER 20, 2021

In 2014 the SGEM looked at a systematic review by Dr. Chris Carpenter , which concluded that there wasn’t a good tool to help us predict which ED patients are at risk of recurrent falls ( SGEM #89 ). Background: We looked at geriatric falls on an SGEM Xtra in 2015. There are three other GEAR 1.0 Reference: Hammouda et al.

ALS 130

ALS ED Emergency Department OR 130

ALiEM

NOVEMBER 29, 2023

Published 2014 Mar 26. Like opioid intoxication, xylazine exposure may result in [4]: Respiratory depression Bradycardia Miosis Hypotension CNS depression Skin findings from chronic use range from superficial ulcerations and cellulitis to severe soft tissue destruction either at or distant from the IV injection sites. Forensic Sci Int.

Naloxone 169

Naloxone Overdose Epinephrine ALS 169

The Skeptics' Guide to EM

OCTOBER 22, 2017

Oxygen supplementation in non-hypoxemic patients with acute myocardial infarction has been a hot topic since the publication of the AVOID-trial ( Stub et al Circulation 2014). However, this difference between the two groups was not statistically significant (relative risk 0.9; What would you rather have, more death or less VT?

Emergency Medical Services 130

Emergency Medical Services Coronary ALS STEMI 130

ACEP Now

AUGUST 14, 2024

This recommendation is a departure from the 2014 guideline iteration that only recommended against CCBs in patients with decompensated heart failure. The American Heart Association and American College of Cardiology released a comprehensive guideline on the management of atrial fibrillation (AF). based care of ED patients with AFRVR.

ALS 105

ALS Emergency Department ED OR 105

Don't Forget the Bubbles

MAY 29, 2023

Explored in seminal research, incivility is described as “ behaviours or mistreatment which violate the workplace norms of mutual respect “ Incivility isn’t just about obvious aggression but can take the form of passive aggression, public beratement, intimidation or habitual interruption. link] Isn’t it just ‘part of the job?’

Critical Care 98

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

The Skeptics' Guide to EM

MAY 1, 2021

A 2014 Cochrane review by Wardlaw et al and arrived at similar conclusions with significant improvement in neurologic outcomes, increased intracranial hemorrhage, and increased mortality [3]. Their efficacy endpoint was good functional outcome, defined as a modified Rankin Score (mRS) of 3 or less.

ALS 130

ALS OR 130