Dr. Smith's ECG Blog

DECEMBER 27, 2023

The definition requires the following three components: An end QRS notch (sometimes called a J wave) or slur, in the case of a slur it must lie entirely above the isoelectric baseline The peak amplitude of the notch or slur should be ≥ 0.1 In leads aVL and III, we see a change in ST segment morphology from markedly concave to much more angular.

E-9-1-1 122

E-9-1-1 OR Coronary ACS 122

ALiEM

FEBRUARY 9, 2024

Let’s apply the ESC 2020 0/1 hour pathway [2], with some modifications based on the 2022 ACC guidelines [1]: Figure 1. Low-risk patients do not routinely require stress testing in the ED. Applying the 2022 ACC guideline Before delving into the specifics of the hs-cTn pathways, start with the ECG.

E-9-1-1 276

E-9-1-1 ED Coronary ALS 276

The Skeptics' Guide to EM

JANUARY 30, 2021

2020 Case: A healthy 55-year-old woman was out for a walk and had a FOOSH (fall on outstretched hand) of her dominant arm. 2020 * Population: Adults (18 years and older) inpatient or outpatients with a diagnosis of certain long bone fractures (neck of femur/tibia/fibula/tibia and fibula/radius/ulna/humerus/clavicle) based on ICD-9 codes.

OR 130

OR ALS 130

The Skeptics' Guide to EM

SEPTEMBER 6, 2020

Date: August 27th, 2020 Guest Skeptic: Dr. Malthaner is the Chair/Chief of the Division of Thoracic Surgery, Director of Thoracic Surgery Research and Simulation, and Professor in the Departments of Surgery, Oncology, and Epidemiology and Biostatistics at the Schulich School of Medicine and Dentistry and Western University. What do you do?

OR 100

OR ALS Emergency Department 100

The Skeptics' Guide to EM

DECEMBER 21, 2019

It will be covered as an SGEM Xtra in 2020. Mathew Reeves is a Professor and Interim Chair of the Department of Epidemiology and Biostatistics at the College of Human Medicine at MSU. Dr. Joshua Reynolds is […] The post SGEM Xtra: NNT – WET or DRI first appeared on The Skeptics Guide to Emergency Medicine. It would be a cross over trial.

OR 100

OR ALS ED 100

ACEP Now

JULY 7, 2023

17 While previous evidence for the use of ECMO in refractory VF arrest has come from observational studies, the ARREST trial in 2020 represented the first open-label randomized trial evaluating the use of ECMO in the management of patients presenting to the ED in refractory VF arrest. amiodarone or lidocaine).

Defibrillator 98

Defibrillator OR ALS Epinephrine 98

ALiEM

OCTOBER 25, 2024

2020 Jun 15;101(12):740-747. Additional Images Physical Exam Extremities : When palpating the right forearm, multiple linear hard objects are felt in the subcutaneous tissue. The patient can flex/extend the wrist, supinate and pronate, and flex/extend the elbow without issue. No erythema or fluctuance. No obvious insertion site noted.

ED 177

ED OR 177

The Skeptics' Guide to EM

OCTOBER 12, 2024

June 2024 Population: Children aged 7-17 years and their caregivers who presented to ten Canadian pediatric EDs between 2018 and 2020 Excluded: Children who remained medically unstable during their ED stay, had altered levels of consciousness, were suspected of being abused, or had a caregiver who was not their legal guardian​.

Emergency Department 229

Emergency Department ED ALS OR 229

Core EM

JANUARY 25, 2024

UpToDate; Jul 17, 2020. Hosts: Joseph Offenbacher, MD Audrey Bree Tse, MD [link] Download Leave a Comment Tags: calcium , Critical Care , Endocrine Show Notes Swami’s CoreEM Post Hypocalcemia Repletion: IV calcium supplementation with 100-300 mg Ca2+ raises serum Ca2+ by 0.5 – 1.5 Diagnosis and management of hypocalcaemia. Goltzman, D.

Critical Care 246

Critical Care ED ALS OR 246

Pediatric EM Morsels

JUNE 9, 2023

Luoto, 2020 ] Increase resistance can be related to pre-hepatic , intra-hepatic , or post-hepatic etiologies. Luoto, 2020 ] Increase resistance can be related to pre-hepatic , intra-hepatic , or post-hepatic etiologies. Banc-Husu, 2023 ; Luoto, 2020; Carneiro de Moura, 2018 ] Basics are best (always)! Keep patient comfortable.

OR 152

OR Critical Care EMS 152

Dr. Smith's ECG Blog

NOVEMBER 29, 2023

Smith : this ECG is definitely not OMI, but could be mistaken for Swirl pattern, which is a septal OMI with STE in V1 and STD in V6. See these cases: Precordial Swirl -- 20 cases of Swirl or Look-Alikes Subsequent serial high sensitivity troponin I measurements were all below the level of detection. AMI was ruled out altogether.

OR 120

OR STEMI EMS ED 120

The Skeptics' Guide to EM

JUNE 20, 2020

Date: June 14th, 2020 Guest Skeptic: Dr. Dennis Ren is a Pediatric Emergency Medicine fellow at Children’s National Hospital in Washington, DC. Date: June 14th, 2020 Guest Skeptic: Dr. Dennis Ren is a Pediatric Emergency Medicine fellow at Children’s National Hospital in Washington, DC. Reference: Kuppermann et al. JAMA Pediatr.

OR 100

OR Emergency Department ALS ED 100

Dr. Smith's ECG Blog

OCTOBER 15, 2022

I further explore this concept in detail in My Comment — at the bottom of the page in the February 6, 2020 post in Dr. Smith's ECG Blog. Smith's Blog ( See especially My Comment at the bottom of the page in the June 20, 2020 post). This is why ST Depression is one of the Exclusions to using the LAD Occlusion/Normal Variant Formula.

OR 52

OR E-9-1-1 STEMI 52

Pediatric EM Morsels

JULY 19, 2024

2020 Sep;38(9):1943. Epub 2020 Jan 29. Your support staff…depending on the amount of bleeding, you are about to have your hands full and may need IV access, medications, airway management, etc. Get a hold of ENT early as OR management and/or admission are common. Set up suction x2 in the room! Headlamps can also be helpful!

E-9-1-1 286

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

ALiEM

OCTOBER 11, 2024

2020 Jan 28;4(2):252. On the day of presentation, she developed a painful, intermittently bleeding “blood blister” to the left lower cheek that had increased in size, as well as new red spots on her arms and legs. She reported no recent trauma or history of similar lesions in the past. Physical Exam Vitals : 98.3°F; Plt 6, WBC 10.3

OR 152

OR ALS 152

Pediatric EM Morsels

AUGUST 11, 2023

2020 Oct 24;12(10):e11141. Coli Proteus species Non-Abscess infection: Staphylococcus aures = the most common Pseudomonas aeruginosa and others still may be seen Perichondritis of the Ear: Presentation Redness , Pain , and Swelling of the pinna Typically spares the lobule ! ” Those areas have very important and delicate structures.

EMS 130

EMS OR 130

ALiEM

MARCH 15, 2024

2020, March 18). Pressure: OD (21), OS (16). Decreased visual field on the right when compared to the left. Staining with tetracaine and fluorescein did not reveal any evidence of corneal abrasion or ulceration. Left eye is atraumatic in appearance. References Cline, D., Meckler, G. Stapczynski, J. Thomas, S. Tintinalli, J. Traumatic Hyphema.

ED 161

ED OR 161

Pediatric EM Morsels

APRIL 7, 2023

American Society of Hematology 2020 guidelines for sickle cell disease: prevention, diagnosis, and treatment of cerebrovascular disease in children and adults. 2020 Apr 28;4(8):1554-1588. DeBaun MR, Jordan LC, King AA, Schatz J, Vichinsky E, Fox CK, McKinstry RC, Telfer P, Kraut MA, Daraz L, Kirkham FJ, Murad MH. 2019001142.

ALS 130

ALS OR Critical Care EMS 130

Pediatric EM Morsels

APRIL 5, 2024

This is true of hard ticks , which carry the majority of bacteria and viruses which can infect humans (Rochlin 2020) This is not true when the infectious agent is carried by a soft tick. Rochlin 2020) Shares many of the same symptoms as African tick-bite fever. In the US, outbreaks have been linked to rental cabins near national parks.

E-9-1-1 161

E-9-1-1 ALS OR EMS 161

ALiEM

MARCH 18, 2024

2020 Apr;87(4):194. Shortly after that, the finger turned purple, so she came to the Emergency Department for evaluation. She denied pain in the hand and has had no problems moving the finger. She denied trauma to the hand or finger. No other complaints or issues. EJVES Short Rep. 2018 Jun 27;40:1-2. doi: 10.1016/j.ejvssr.2018.05.008.

Emergency Department 306

Emergency Department ED OR 306

Pediatric EM Morsels

OCTOBER 27, 2023

DeBoer 2020] Now seen as industry standard in pediatric emergency care. K 2020] In Mexican children, the Broselow differed from actual weight by <10% in 46-64% of patients. 2020) The Times & Tapes Are a-Changin’: The Latest Broselow-Luten Tape for EMS , EMS World. Came out in 1986. Recommended by ATLS and PALS.

E-9-1-1 269

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

Dr. Smith's ECG Blog

DECEMBER 12, 2022

Here is the OMI progression of ECG findings for review: You can see that OMI ECG findings must "deflate" and pass through normal or near-normal in order to get to reperfusion findings. In other words, to get from hyperacute T waves and STE to terminal T wave inversion, the ST and T wave must pass transiently through a state of near-normal.

OR 52

OR ACS STEMI Coronary 52

Pediatric EM Morsels

AUGUST 9, 2024

2019, there were 1,875 and this trend has continued to increase (2,157 case in 2020; 2,855 cases in 2021). Neonates presenting to the Emergency Department often cause a lot of uncertainty. Is this scalp swelling normal? Is this bloody stool concerning? Are this odd movements part of normal development? Is that umbilical area ok or concerning?

E-9-1-1 152

E-9-1-1 Plasma Emergency Department OR 152

ALiEM

JANUARY 26, 2024

Epub 2020 Dec 3. The patient stated that she was started on Cipro eyedrops 1 or 2 days prior to presentation for a possible eye infection. A day prior to presentation she developed a purple purpuric rash on her lower extremities that gradually progressed up her legs, and was present on her buttocks thighs, and lower legs. Dermatol Ther.

EMS 183

EMS OR 183

Pediatric EM Morsels

MAY 10, 2024

Pediatr Rev September 2020; 41 (9): 469–480. Ask about suicidal ideation : Let’s not miss a caustic ingestion… Ask about birth control : Teens may be on OCPs and at increased risk for PE and their parents don’t know it Ask about drugs : Does your patient smoke, vape, or use cocaine? Has anyone in the family died unexpectedly before age 50?

E-9-1-1 268

E-9-1-1 OR EMS 268

The Overrun

MAY 18, 2020

The idea is to recognize and thank the clinicians in the prehospital and mobile health profession who do a very unique job under challenging circumstances, any day, anytime, anywhere. Signs entering ambulance bays around the US, and the world for that matter; point out in no uncertain terms that “HEROES WORK HERE”. Or don’t know what it means.

EMS 52

EMS Firefighter Paramedicine Paramedicine 52

Pediatric EM Morsels

JULY 26, 2024

2020 Feb;75:55-62. While it is important for us to maintain a safe work environment for our patients and our team, managing the agitated patient requires more of us than administering Droperidol or Ketamine. Make sure to consult your friendly neighborhood pediatric neurologist and/or rheumatologist! The prevalence ranges from 12.5%-61%

Plasma 269

Plasma OR ED Critical Care 269

The Skeptics' Guide to EM

MARCH 18, 2023

Association of early oseltamivir with improved outcomes in hospitalized children with influenza, 2007-2020. Association of early oseltamivir with improved outcomes in hospitalized children with influenza, 2007-2020. Association of early oseltamivir with improved outcomes in hospitalized children with influenza, 2007-2020.

ICU 101

ICU Emergency Department OR 101

The Skeptics' Guide to EM

DECEMBER 12, 2020

Date: December 10th, 2020 Reference: Ladde et al. AEM December 2020 Guest Skeptic: Dr. Kirsty Challen (@KirstyChallen) is a Consultant in Emergency Medicine and Emergency Medicine Research Lead at Lancashire Teaching Hospitals Trust (North West England). Date: December 10th, 2020 Reference: Ladde et al.

ALS 130

ALS ED Emergency Department OR 130

Pediatric EM Morsels

NOVEMBER 3, 2023

falciparum accounts for >70% of cases of imported malaria , primarily seen in those returning from travel in Sub-Saharan Africa (Mischlinger 2020) Other species include P. Worldwide, children <5 years old account for 76% of deaths related to malaria, but these are predominantly in Sub-Saharan Africa (WHO 2022) P. vivax , P.

ALS 278

ALS Critical Care EMS OR 278

Dr. Smith's ECG Blog

OCTOBER 20, 2024

Figure-1: Reasons for the varied ECG presentation of acute LMain occlusion — excerpted from Dr. Smith’s 8/9/2019 post ( This Table from My Comment in the January 16, 2020 post ). Below (Figure A) I have marked the end of the QRS complexes by drawing a vertical line through the J-point of the standard and precordial leads.

Coronary 127

Coronary ACS Emergency Department Defibrillator 127

Core EM

JANUARY 25, 2024

Paydary, 2020) Patients with a score of 5 or greater require ADAMTS-13 levels to be sent along with expert consultation and likely initiation of empiric therapy. link] ) Laboratory Evaluation: Clinical presentation and laboratory findings can help suggest TTP in the emergency department.

Plasma 246

Plasma Frozen Plasma Emergency Department FFP 246

Pulsara

AUGUST 22, 2024

In 2020, the State of Arkansas launched an initiative to improve treatment times for time-sensitive emergencies. When Baptist Health Medical Center - North Little Rock needed to communicate about incoming stroke patients or transfer an LVO patient to their sister facility, the team was using a call system. “In Things were delayed.”

EMS 97

EMS OR 97

This Podcast Will Kill You

JULY 23, 2024

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. Everyone went on gluten-free diets or knew someone with a gluten intolerance or sensitivity. Burki, Talha Khan. 2019): 100.

E-9-1-1 98

E-9-1-1 ALS OR 98

ALiEM

NOVEMBER 13, 2023

2020 Jul 7;95(1):e70-e78. Epub 2020 Jun 2. There is a macular, violaceous rash to the upper back and upper thighs. The patient’s hands are slightly edematous with nontender papules on the palmar aspect of the hands. CV : Heart sounds are normal. No jugular venous distention or lower extremity edema. doi: 10.1212/WNL.0000000000009727.

OR 200

OR 200

REBEL EM

MARCH 6, 2024

Dietary Guidelines for Americans, 2020-2025. December 2020. Published 2020 Oct 27. Evidence from constant routine studies. 1983 Dec;345:451-67. doi: 10.1113/jphysiol.1983.sp014988. PMID: 6663508; PMCID: PMC1193807. Crowley SJ, Lee C, Tseng CY, Fogg LF, Eastman CI. 2004 Sep 15;27(6):1077-87. doi: 10.1093/sleep/27.6.1077.

ALS 105

ALS OR EMS 105

The Skeptics' Guide to EM

AUGUST 14, 2021

Circulation 2020 Guest Skeptic: Missy Carter is a PA practicing in emergency medicine in the Seattle area and an adjunct faculty member with the Tacoma Community College paramedic program. Date: August 12th, 2021 Reference: Daya et al. first appeared on The Skeptics Guide to Emergency Medicine. Date: August 12th, 2021 Reference: Daya et al.

CPR 130

CPR BLS ALS Paramedic 130