Don't Forget the Bubbles

SEPTEMBER 13, 2023

The parents of 18-month-old Susie brought her to the Emergency Department after she had a seizure at home. 2019-0134 Hirtz D, Ashwal S, Berg A, et al. The role of brain computed tomography in evaluating children with new onset of seizures in the emergency department. ACR Appropriateness Criteria® Seizures-Child.

E-9-1-1 131

E-9-1-1 Emergency Department ALS OR 131

Dr. Smith's ECG Blog

NOVEMBER 4, 2022

Smith: If this is ACS (a big if), t his is just the time when one should NOT use "upstream" dual anti-platelet therapy ("upstream" means in the ED before angiography). History sounds concerning for ACS (could be critical stenosis, triple vessel), but differential also includes dissection, GI bleed, etc. Am J Med 2019, 132(5):622-630.

Coronary 52

Coronary ACS STEMI ALS 52

Dr. Smith's ECG Blog

OCTOBER 12, 2024

A man in his 90s with a history of HTN, CKD, COPD, and OSA presented to the emergency department after being found unresponsive at home. Vital signs were within normal limits on arrival to the Emergency Department. Written by Bobby Nicholson What do you think of this “STEMI”? Blood glucose was not low at 162 mg/dL.

STEMI 98

STEMI Coronary Emergency Department OR 98

Don't Forget the Bubbles

JULY 22, 2024

References BTS_SIGN Guideline for the management of asthma 2019.pdf. A Randomized Trial of Single-Dose Oral Dexamethasone Versus Multidose Prednisolone for Acute Exacerbations of Asthma in Children Who Attend the Emergency Department. Annals of Emergency Medicine. 2019 Aug;9(8):e028511. 2016 May;67(5):593-601.e3.

E-9-1-1 105

E-9-1-1 ALS ACS ED 105

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. Davidson L, Foley DA, Clifford P, Blyth CC, Bowen AC, Hazelton B, et al.

Emergency Department 143

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

Don't Forget the Bubbles

JULY 5, 2023

Opioids do not cause ACS but they can exacerbate hypoxia in patients with ACS. A 6-year-old girl from Saudi Arabia was referred by her General Practitioner to the local emergency department. Mechanical or non-invasive ventilation : children with ACS may require ventilatory support.

E-9-1-1 126

E-9-1-1 ACS OR ICU 126

EMDocs

FEBRUARY 12, 2024

Correlation and agreement between arterial and venous blood gas analysis in patients with hypotension-an emergency department-based cross-sectional study. Int J Emerg Med. The role of venous blood gas in the emergency department: a systematic review and meta-analysis. Eur J Emerg Med. Emerg Med J.

Emergency Department 94

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

EMDocs

JUNE 27, 2024

2019 Jan 24;14:263-292. Am J Emerg Med. Chinawa JM, Ubesie AC, Chukwu BF, Ikefuna AN, Emodi IJ. Intranasal fentanyl and discharge from the emergency department among children with sickle cell disease and vaso-occlusive pain: A multicenter pediatric emergency medicine perspective. C or 100.4 mg/kg, max 0.4

E-9-1-1 75

E-9-1-1 ICU ACS EMS 75

EMDocs

JUNE 14, 2023

Tintinalli’s Emergency Medicine: A Comprehensive Study Guide, 9th Edition. Parenteral organophosphorus poisoning in a rural emergency department: a case report. doi:10.1080/10773525.2015.1123848 Povey AC, Rees HG, Thompson JP, Watkins G, Stocks SJ, Karalliedde L. Treatment mainstay is avoidance of further exposure.

E-9-1-1 70

E-9-1-1 Emergency Department Plasma ED 70

Dr. Smith's ECG Blog

JANUARY 9, 2024

She presented to the emergency department after a couple of days of chest discomfort. Ischemia from ACS causing the chest discomfort, with VT another consequence (or coincidence)? She had a single chamber ICD/Pacemaker implanted several years prior due to ventricular tachycardia. The ECG below was recorded.

Coronary 99

Coronary ACS ED OR 99

EMDocs

JUNE 7, 2023

Parenteral organophosphorus poisoning in a rural emergency department: a case report. 12784 Povey AC, Rees HG, Thompson JP, Watkins G, Stocks SJ, Karalliedde L. Tintinalli’s Emergency Medicine: A Comprehensive Study Guide, 9th Edition. She is speaking one word at a time and constantly coughing. BMC Res Notes.

E-9-1-1 83

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

EMDocs

SEPTEMBER 25, 2023

References: Heffner AC et al. Incidence and factors associated with cardiac arrest complicating emergency airway management. actors Associated with the Occurrence of Cardiac Arrest after Emergency Tracheal Intubation in the Emergency Department. Int J Emerg Med. J Emerg Med. 2019, 64:617-28.

ED 65

ED Emergency Department ALS Paramedic 65

Dr. Smith's ECG Blog

OCTOBER 25, 2023

A man in his 60s with a history of severe alcohol use disorder and epidural abscess on long-term ciprofloxacin presented to the emergency department after an episode of syncope while standing in line at a grocery store. Moreover, the Queen is only supposed to be used with a high pretest probability of ACS/OMI.

Overdose 112

Overdose OR ACS ICU 112

FOAMfrat

OCTOBER 20, 2023

Heffner AC, Swords DS, Neale MN, Jones AE. Incidence and factors associated with cardiac arrest complicating emergency airway management. Peri-intubation cardiac arrest in the Emergency Department: A National Emergency Airway Registry (NEAR) study. Intern Emerg Med. Acad Emerg Med. Bull Emerg Trauma.

E-9-1-1 52

E-9-1-1 ALS ACS OR 52

Don't Forget the Bubbles

JUNE 30, 2023

Interim results presented earlier this year show that REBOA performed within the Emergency Department increased mortality. b) Emergency thoracotomy Let’s be clear: YOU will not be doing any of this. Interim results presented earlier this year show that REBOA performed within the Emergency Department increased mortality.

E-9-1-1 139

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

Dr. Smith's ECG Blog

NOVEMBER 12, 2020

Clin Chem [Internet] 2020;Available from: [link] Smith mini-review: Troponin in Emergency Department COVID patients Cardiac Troponin (cTn) is a nonspecific marker of myocardial injury. Cardiovascular Implications of Fatal Outcomes of Patients With Coronavirus Disease 2019 (COVID-19). of Cardiology AC, Others.

E-9-1-1 52

E-9-1-1 STEMI Coronary ALS 52

Dr. Smith's ECG Blog

AUGUST 26, 2019

She was brought to the Emergency Department and this ECG was recorded while she was still feeling nauseous but denied chest pain, shortness of breath, or other symptoms: What do you think? I wouldn't activate the lab for this EKG alone, but if the patient is clinically compatible with ACS you could call a heart alert.

STEMI 52

STEMI Coronary OR ED 52

Dr. Smith's ECG Blog

FEBRUARY 5, 2019

The clinicians later stated they had had no suspicion of ACS, but that the faculty wanted a troponin anyway. Design Prospective study of three independent consecutive patient populations presenting to emergency departments. Setting Secondary and tertiary care hospitals in the United Kingdom and United States.

STEMI 52

STEMI Emergency Department ED OR 52

EMDocs

JANUARY 20, 2024

Takotsubo syndrome is often exceedingly difficult to distinguish from acute myocardial infarction in the emergency department, as there is significant overlap in many clinical and diagnostic features. She reports worsening dyspnea on exertion for the past 2 days and a recent diarrheal illness that resolved without treatment 4 days ago.

E-9-1-1 74

E-9-1-1 EMS Coronary ACS 74

ACEP Now

NOVEMBER 7, 2023

A 67-year-old man presents to the emergency department (ED) in cardiac arrest. 8-12 A recent scoping review published in The American Journal of Emergency Medicine reviewed articles between 2016 and 2019, and found 18 observational studies, which failed to demonstrate sufficient evidence for widespread implementation of DSED.

Defibrillator 52

Defibrillator E-9-1-1 ALS Epinephrine 52

Dr. Smith's ECG Blog

JUNE 8, 2023

As recurrent ischaemia is the principle event reduced by early intervention in NSTE-ACS, these are important endpoint events occurring with delayed angiography and there is a consistent signal for harm now from two data sources.”[5] Eur Heart J 2019 5. Kontos et al. J Am Coll Cardiol 2022 Nov 15;80(20):1925-1960 2. Welsh et al.

STEMI 63

STEMI Coronary Paramedic ALS 63