Dr. Smith's ECG Blog

SEPTEMBER 2, 2024

ECG #1 Interpretation: ECG #1 shows sinus rhythm at a heart rate of 77 bpm. Following more detailed questioning — it turned out the patient had started taking 9 different herbal remedies to ease lethargy and unspecific neurological symptoms. For clarity in Figure-1 — I've reproduced the initial ECG in today's case.

E-9-1-1 104

E-9-1-1 ALS Defibrillator OR 104

EMDocs

NOVEMBER 6, 2024

2004;141(1):17-21. What are important clinical features differentiating strychnine and tetanus toxicity to aid with diagnosis? How does the clinical management of strychnine and tetanus differ? Site of action of strychnine and tetanus. red X = target of strychnine = target of tetanus Adapted from: Stephan J. Neurotransmitter.

E-9-1-1 77

E-9-1-1 ALS EMS OR 77

Pediatric EM Morsels

NOVEMBER 17, 2023

2021 Jun;31(6):713-719. Epub 2021 Apr 11. Bibl K, Pracher L, Küng E, Wagner M, Roesner I, Berger A, Hermon M, Werther T. 1994 Jul;125(1):57-62. 2019 Sep;74(9):1186-1190. 2016 Feb;30(1):3-11. Differences in intubation outcomes for pediatric patients between pediatric and general Emergency Departments.

E-9-1-1 183

E-9-1-1 Operating Room Emergency Department ALS 183

This Podcast Will Kill You

JANUARY 16, 2024

Manaresi, E. Hoelzer, Karin, et al. Pt 9 (2008): 2280. History Biology Allison, Andrew B., “Role of multiple hosts in the cross-species transmission and emergence of a pandemic parvovirus.” ” Journal of virology 86.2 2012): 865-872. Heegaard, E.D. and Brown, K.E., Human parvovirus B19. Allison, Andrew B.,

E-9-1-1 95

E-9-1-1 ALS 95

This Podcast Will Kill You

NOVEMBER 27, 2023

” Cambridge: Cambridge University Press 197 (1993): 9-23. Parasites & Vectors , 15 (1), pp.1-9. Global programme to eliminate lymphatic filariasis: progress report, 2021– Weekly Epidemiological Record , 97 (41), pp.513-524. Brown, Amanda MV, et al. The Lancet Global Health , 8 (9), pp.e1186-e1194.

E-9-1-1 52

E-9-1-1 ALS ED 52

ALiEM

OCTOBER 30, 2023

It should be no surprise that academic clinical educators are at high risk for burnout, stalled career advancement, and abandonment of academic medicine altogether [1, 2]. PMID 18945997 Elster MJ, O’Sullivan PS, Muller-Juge V, et al. 2022; 11(1):45-52. PMID 29686766 Jordan J, Coates WC, Clarke S, et al.

E-9-1-1 161

E-9-1-1 ALS OR 161

Don't Forget the Bubbles

JANUARY 17, 2024

After Meshram et al, 2020 When Orbeez are exposed to water, the water molecules diffuse into the polymer network through osmosis. Image adapted from Mullens et al., 2021 A plain abdominal X-ray shows multiple dilated loops of bo wel. After Darracq et al., A recent literature review by Caré et al. Zamora et al.,

E-9-1-1 111

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

Dr. Smith's ECG Blog

DECEMBER 19, 2023

link] A 62 year old man with a history of hypertension, type 2 diabetes mellitus, and carotid artery stenosis called 911 at 9:30 in the morning with complaint of chest pain. Challenge QUESTION: The relative change in T-QRS-D is not the only thing that changes during period of time that passed between recording of the 2 ECGs shown in Figure-1.

E-9-1-1 119

E-9-1-1 Coronary ACS BLS 119

EMS 12-Lead

APRIL 28, 2022

Initial vital signs include: NIBP 99/58 HR 150-160 (trend) RR 10 (spontaneous, but shallow) SpO2 86 (RA) BBS CTA The initial rhythm strip is attached: Figure 1 There is a wide complex tachycardia of varying morphology, amplitude, and R-R cycle length. A prominent vertical scar, however, is noted at the sternum.

E-9-1-1 130

E-9-1-1 ALS Coronary EMS 130

Don't Forget the Bubbles

JULY 22, 2024

Compare this with the Panickar et al. study from 200 9. Fortunately, Lee et al. Lee B, Turner S, Borland M, Csonka P, Grigg J, Guilbert TW, et al. A large proportion of the trials come from Finland (3) and The UK (2) and also from Australia (1) and the US (1), but only a small number took place in the ED.

E-9-1-1 105

E-9-1-1 ALS ACS ED 105

This Podcast Will Kill You

JANUARY 2, 2024

2002): 1-7. Nature Reviews Endocrinology , 7 (9), pp.540-557. Devogelaer, Jean-Pierre, et al. Endocrine reviews , 43 (1), pp.61-90. Molecular and Cellular Pediatrics , 7 (1), pp.1-9. Sochett, E. Annual review of biochemistry , 78 , pp.929-958. ” Annals of Anatomy-Anatomischer Anzeiger 184.1 Forlino, A.,

E-9-1-1 52

E-9-1-1 ALS OR 52

EMDocs

JULY 17, 2023

1 While less common than small bowel obstruction (SBO), obstruction of the large bowel is more likely to be a surgical emergency and is often associated with a serious underlying condition. 1 The most common causes of non-cancer-related LBO are cecal and sigmoid volvulus. Small bowel dilation may also be seen.

E-9-1-1 77

E-9-1-1 ED Operating Room ALS 77

EMDocs

MAY 11, 2024

CT head without contrast 1 is performed and reveals the following: Question: What is the diagnosis? Rosh Review Website Link Further Reading: FOAMed: [link] [link] [link] [link] [link] [link] [link] References : Turi B, Smith D, Kusel K, et al. Updated November 9, 2023. link] Sharma R, Gaillard F, Bell D, et al.

EMS 88

EMS E-9-1-1 ALS OR 88

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

This Podcast Will Kill You

NOVEMBER 12, 2024

1996 Jul;10(9):1002-13. Dermato-endocrinology , 1 (3), pp.162-169. International journal of women’s dermatology , 8 (1), p.e003. Aesthetic Surgery Journal , 30 (1), pp.74-77. The Journal of clinical and aesthetic dermatology , 14 (9), p.33. Bagatin, E., Routledge, 2013. Draelos, ZK, editor. Amichai, B.

E-9-1-1 52

E-9-1-1 ALS ED OR 52

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

This Podcast Will Kill You

SEPTEMBER 10, 2024

Perantoni, E., Kaimakamis, E., Longtin, Yves, et al. JMIR Medical Informatics, 9(1), p.e22753. . “Laennec, the Man—1781–1826.” ” The Boston Medical and Surgical Journal 195.5 1926): 208-211. Lung sounds recordings: Rocha, B.M., Vogiatzis, I., Natsiavas, P., Oliveira, A., Marques, A. Amaral, L.A.,

E-9-1-1 52

E-9-1-1 ALS 52

This Podcast Will Kill You

NOVEMBER 5, 2024

1996 Jul;10(9):1002-13. Dermato-endocrinology , 1 (3), pp.162-169. International journal of women’s dermatology , 8 (1), p.e003. Aesthetic Surgery Journal , 30 (1), pp.74-77. The Journal of clinical and aesthetic dermatology , 14 (9), p.33. Bagatin, E., Routledge, 2013. Draelos, ZK, editor. Amichai, B.

E-9-1-1 52

E-9-1-1 ALS ED OR 52

ACEP Now

JANUARY 9, 2024

FIGURE 1: Abdominal X-ray showing particulate radiopaque foreign bodies involving the stool. 1 Children are particularly vulnerable. 9 Lead exerts its toxic effects by interfering with various organ functions, primarily targeting the nervous system and hematopoietic system, as well as impairing liver and kidney functions.

E-9-1-1 52

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

REBEL EM

JANUARY 25, 2024

Article: Arvig MD, Lassen AT, Gæde PH, et al. What They Did: Design: Randomized, controlled, blinded-outcome trial Sites: Three emergency departments in Denmark Duration: October 9, 2019 to May 26, 2021. The first evaluation of the patient was to be done within 1 hour of arrival to ED (Including the first POCUS).

ED 130

ED E-9-1-1 Emergency Department ALS 130

Don't Forget the Bubbles

MARCH 18, 2024

The Royal Children’s Hospital in Melbourne summarises them in an easy-to-follow flow diagram (figure 1). Typical HUS has a diarrheal prodrome, usually caused by an infection with a Shiga-toxin-producing E. Blood tests Urine Stool Full blood count with blood film Urinalysis Stool MC&S Coagulation Urine MC&S E.

E-9-1-1 59

E-9-1-1 ALS OR 59

REBEL EM

FEBRUARY 21, 2024

One important thing to understand is that the different NSAIDs have widely accepted equianalgesic doses; at the right dose, all NSAIDs (whether it be naproxen, ibuprofen, ketorolac or diclofenac) give equivalent pain relief ( Irizarry 2021 ). Read More REBEL EM: The Ketorolac Analgesic Ceiling References Irizarry E et al.

E-9-1-1 64

E-9-1-1 Emergency Department ALS ED 64

This Podcast Will Kill You

NOVEMBER 7, 2023

New England Journal of Medicine, 355(1), pp.51-65. Nature reviews Disease primers, 1(1), pp.1-20. Lee, Carrie, et al. Craythorne, E. and Al-Niami, F., 2021): 1044-1049. International journal of dermatology, 49(9), pp.978-986. Public Health Research & Practice, 32(1). Miller, A.J.

E-9-1-1 52

E-9-1-1 ALS ED OR 52

ACEP Now

NOVEMBER 8, 2024

1 Prehospital endotracheal intubation and EGAs are typically placed without paralytics and are reserved for unconscious, apneic, and out-of-hospital cardiac arrest patients. 9 LMAs use an inflatable mask expanded using a similar technique to the endotracheal tube cuff. Published August 2021. Benger JR, Kirby K, Black S, et al.

E-9-1-1 52

E-9-1-1 Emergency Medical Services Emergency Medical Technician AEMT 52

NAEMSP

APRIL 19, 2023

Current AHA guidelines do not recommend routine use of calcium in cardiac arrest (Panchal, et al., Calcium acts as a vasopressor and inotropic agent (Lindqwister, et al., This CI does include 1; and further and further analysis of the data showed that the likelihood that calcium has a beneficial effect (e.g.

E-9-1-1 52

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

FOAMfrat

OCTOBER 20, 2023

As reported within the 6th edition Manual of Emergency Airway Management, there are cardiac arrest rates between 1% and 4%, with other complications (mostly hypoxemia and hypotension) as high as 30% in patients with first-pass success [1, pg 29; 4-10]. And according to a paper from Russotto et al. So, how do we do it?

E-9-1-1 52

E-9-1-1 ALS ACS OR 52

Pediatric EM Morsels

AUGUST 18, 2023

Myth #1: Musculoskeletal Adverse Events (MAE) This concern is likely the most common reason fluoroquinolones are rarely used in children. Which is a risk of 1 event for 62.5 Ross 2021) Predisposing risk factors including older age , trauma to tendons or joints , and a family history of MAEs. Arthropathy was seen in 13.7%

E-9-1-1 130

E-9-1-1 OR ACS ALS 130

EMDocs

JANUARY 17, 2024

1) There are a limited number of antitussives on the US market which include benzonatate, codeine, dextromethorphan, diphenhydramine, and hydrocodone. 9) The safety announcement highlighted the mortality risk of exploratory ingestions in children under 10 years. What are the treatment options for a benzonatate overdose?

E-9-1-1 67

E-9-1-1 Overdose Emergency Medical Services Life Support 67

NAEMSP

JANUARY 5, 2023

1] The Adult Cardiac Arrest ACLS algorithm currently includes epinephrine and either amiodarone or lidocaine as recommended pharmacologic therapies. al answered this question with a prospective observational study which showed a significantly shorter time interval to obtain tibial IO access (4.6 1] Table from Hamam et al.

E-9-1-1 52

E-9-1-1 Advanced Life Support Epinephrine Life Support 52

EMDocs

AUGUST 22, 2024

1 However, we recognize that many patients prefer to speak a language other than English regardless of their English proficiency, and this does not indicate a deficiency. 9 Less likely to be satisfied with their care and have a lower understanding of their discharge instructions. Lion KC, et al. Regenstein M, et al.

Emergency Department 81

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

Dr. Smith's ECG Blog

NOVEMBER 15, 2023

Post cath ECG: Now there are hyperacute T-waves again, and recurrent ST depression in V2 This ECG would normally diagnostic of OMI until proven otherwise No further troponins were measured, but it looks like there is recurrent OMI Next day: A CT Coronary Angiogram was done (CTCA) CARDIAC MORPHOLOGY AND FUNCTION: 1. IMPRESSION: 1.

Coronary 102

Coronary E-9-1-1 STEMI ACS 102

EMDocs

NOVEMBER 18, 2023

A point of care ultrasound of the liver reveals the following: Image 1: Ultrasound of the liver showing abnormal hepatic artery flow and resistance index 1 Question: What is the diagnosis? Rosh Review Website Link References 1) Karmazyn B, Sağlam D, Rao GS, Jennings SG, Mangus RS. In: Molmenti E, Santibañes M, Santibañes E.

EMS 69

EMS E-9-1-1 ALS Emergency Department 69

ECG & Echo Learning

OCTOBER 2, 2022

Most agents exhibit both vasopressor and inotropic effects (Figure 1). μg/kg/min Bolus : 1 mg IV every 3 to 5 min (max 0.2 mg/kg) IM: (1:1000): 0.1 mg (max 1 mg) Safe for peripheral use ++ + N/A Beta-effect more pronounced at low doses. References Overgaard, Dzavik et al. Jentzer et al. Circulation 2011.

E-9-1-1 52

E-9-1-1 ALS Coronary Epinephrine 52

REBEL EM

AUGUST 28, 2023

One important thing to understand is that the different NSAIDs have widely accepted equianalgesic doses; at the right dose, all NSAIDs (whether it be naproxen, ibuprofen, ketorolac or diclofenac) give equivalent pain relief ( Irizarry 2021 ). Read More REBEL EM: The Ketorolac Analgesic Ceiling References Irizarry E et al.

E-9-1-1 52

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

Broome Docs

OCTOBER 31, 2022

2022 Jan;48(1):78-91. Epub 2021 Dec 14. The PEACH trial: No body had a fit, so… we have no clue Peter-Derex L, Philippeau F, Garnier P, et al. 2022 Sep;21(9):781-791. PMID: 30206143 Less is more when it comes to intravenous fluids de-Madaria E, Buxbaum JL, Maisonneuve P, et al. Intensive Care Med.

E-9-1-1 52

E-9-1-1 Defibrillator ICU Critical Care 52

EMDocs

NOVEMBER 4, 2023

McGraw Hill; 2021. link] =2969&sectionid=250456991 Moran GJ, Krishnadasan A, Gorwitz RJ, et al. 2008;1(1):165. doi:10.1186/1757-1626-1-165 Hackett B, Sletten Z, Bridwell R E (July 03, 2020) Testicular Abscess and Ischemia Secondary to Epididymo-orchitis. Radiographics. 2013;33(3):721-740. doi:10.1148/rg.333125158

EMS 68

EMS E-9-1-1 Emergency Department ALS 68

Broome Docs

JANUARY 30, 2023

Vedantham S, Goldhaber SZ, Julian JA, et al; ATTRACT Trial Investigators. 2021 Aug;78(2):253-266. Epub 2021 Apr 29. PMID: 33933300 Khan A, Saleem MS, Willner KD, Sullivan L, Yu E, Mahmoud O, Alsaid A, Matsumura ME. 2022 Sep 1;5(9):e2235575. doi: 10.1007/s00381-022-05455-1. N Engl J Med. 2022 Nov 6.

E-9-1-1 52

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