Dr. Smith's ECG Blog

OCTOBER 1, 2023

This is a re-post of an excellent case from 2021. See the full post here == MY Comment , by K EN G RAUER, MD ( 10/1 /2023 ): == It is often insightful to "look back" — and see from where we have come, which Dr. Meyers skillfully does with today's repost from October 5, 2021. We've come a long way in 2 years!

OR 129

OR STEMI Coronary CAD 129

ALiEM

APRIL 10, 2023

Updated 2021 Jun 30]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Copyright Images and cases from the Society of Academic Emergency Medicine (SAEM) Clinical Images Exhibit at the 2021 SAEM Annual Meeting | Copyrighted by SAEM 2021 – all rights reserved. References Diaz-Frias J, Badri T. doi: 10.1111/j.1087-0024.2004.00827.x.

OR 246

OR 246

ALiEM

NOVEMBER 17, 2023

link] Published 2021. link] Published 2021. The grandmother first noted blood in the patient’s underwear the previous morning when she was helping the patient wipe and she noticed it again prior to arrival, this time saturating the patient’s underwear. The patient in this case was treated with a 4-week estrogen cream taper.

Emergency Department 250

Emergency Department OR 250

ALiEM

AUGUST 7, 2023

Copyright Images and cases from the Society of Academic Emergency Medicine (SAEM) Clinical Images Exhibit at the 2021 SAEM Annual Meeting | Copyrighted by SAEM 2021 – all rights reserved. The patient is reluctant to abduct the right arm secondary to pain. Conversely, posterior dislocations are more serious but less common.

Emergency Department 246

Emergency Department OR EMS ED 246

Pediatric EM Morsels

OCTOBER 6, 2023

The most common countries of acquisition were Bangladesh, India, Nepal, and Pakistan (Forster 2021) For travelers, the peak incidence occurs at age 10 and those who are visiting to their country of birth. Rauniyar 2021) Up to 10% of patients may present with constipation as opposed to diarrhea. Shah 2021).

OR 161

OR EMS ED 161

Pediatric EM Morsels

MAY 5, 2023

Vegan Diets in Children: Basics Vegan Diets avoid/prohibit consumption of any animal products Exclusion of meat, eggs, honey, dairy products, etc This is often adopted due to heightened concern of animal maltreatment, but also for religious reasons or health benefits Roughly 2-5% of Western nation populations follow a vegan based diet (Sutter, 2021) (..)

E-9-1-1 130

E-9-1-1 OR EMS 130

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). Early Congenital Syphilis Present before 2 years of age [ Hussain, 2023 ; Foles, 2024; Fang, 2022; Morrisroe, 2021 ] Only ~33% of newborns present with symptoms at birth and can be subtle. Is this scalp swelling normal?

E-9-1-1 152

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

Pediatric EM Morsels

APRIL 5, 2024

Silva-Ramos 2021) Majority of cases arise from travel to South Africa. (Silva-Ramos 2021) Majority of cases arise from travel to South Africa. (Frean 2019) The classic triad described is fever, eschar and rash. Silva-Ramos 2021) Fever and a characteristic eschar (tache noir) are seen 90% of the time.

E-9-1-1 161

E-9-1-1 ALS OR EMS 161

Pediatric EM Morsels

MARCH 17, 2023

In the US, the venomous snakes include rattlesnakes , copperheads, cottonmouths/water moccasins , and coral snakes [ CDC, 2021 ] Rattlesnakes live all across the United State s Copperheads inhabit the eastern U.S. Usually, animals bite from fear or defense of their offspring ( ex, Brown Recluse ).

Frozen Plasma 130

Frozen Plasma First Aid Plasma OR 130

Core EM

JULY 23, 2024

Author: Mallika Singh, MD Editor: Jonathan Kobles, MD Background Unintentional or intentional exposure to radiological material represents a potential threat to human health on the individual to mass-casualty scale. Radioactive sources include medical isotopes, fuel rods, generators, and other industrial sources. 10-Hour Flight: 0.03

ALS 130

ALS OR Emergency Department ED 130

ALiEM

NOVEMBER 10, 2023

2021 Sep 1;57(9):925. Epub 2021 Jul 1. 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]. References Anderson HJ, Lee JB. Medicina (Kaunas).

Emergency Department 161

Emergency Department OR 161

ALiEM

AUGUST 21, 2023

McGraw Hill; 2021. Copyright Images and cases from the Society of Academic Emergency Medicine (SAEM) Clinical Images Exhibit at the 2021 SAEM Annual Meeting | Copyrighted by SAEM 2021 – all rights reserved. Radiographs may be performed to evaluate for occult traumatic injury or foreign body. References Ritter K, Fitch R.

OR 130

OR ED 130

The Skeptics' Guide to EM

APRIL 20, 2024

The evidence was not robust enough back in 2021 to confidently use this potential tool. An attempt was made to externally validate this tool in New Zealand by Murkerji et al 2021 [4]. Background: We have covered rib fractures once before on the Skeptics’ Guide to Emergency Medicine.

Emergency Department 204

Emergency Department Overdose ALS ED 204

Core EM

JANUARY 25, 2024

Updated 2021 Jul 27]. EVALUATION: Scan the affected and contralateral body part for comparison with a sterile cover (or Tegaderm) overlying a high frequency linear probe. REFERENCES: Castleberg E, Jenson N, Dinh VA. Diagnosis of necrotizing faciitis with bedside ultrasound: The staff exam. Western Journal of Emergency Medicine.

E-9-1-1 246

E-9-1-1 Emergency Department OR 246

The Skeptics' Guide to EM

AUGUST 24, 2024

The evidence was not robust enough back in 2021 to confidently use this potential tool. We have covered rib fractures twice on the SGEM. SGEM episode #324 looked at using spirometry to guide discharging older patients with rib fractures. Reference: Partyka et al. Comparison: Standard protocolized rib fracture care alone without the SAPB.

Emergency Department 127

Emergency Department ALS OR ED 127

ALiEM

JANUARY 26, 2024

2021 Jan;34(1):e14591. 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. PMID: 7711355.

EMS 183

EMS OR 183

The Skeptics' Guide to EM

DECEMBER 25, 2021

Date: December 21st, 2021 Guest Skeptic: Dr. Spencer Greaves is an Emergency Medicine resident at Florida Atlantic University. Date: December 21st, 2021 Guest Skeptic: Dr. Spencer Greaves is an Emergency Medicine resident at Florida Atlantic University. Spencer completed his medical doctorate at the Medical College of Wisconsin.

Epinephrine 130

Epinephrine CPR ALS Emergency Department 130

Pediatric EM Morsels

JULY 26, 2024

2021 Oct 9;22(20):10911. 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 265

Plasma OR ED Critical Care 265

The Skeptics' Guide to EM

FEBRUARY 19, 2022

CMAJ 2021 TRIGGER WARNING: As a warning to those listening to the podcast or […] The post SGEM Xtra: Everybody Hurts, Sometime first appeared on The Skeptics Guide to Emergency Medicine. The title of the article was “Physician, heal thyself” and was in the humanities section of the October 2021 issue. Reference: Graham T.

Emergency Department 130

Emergency Department ALS OR 130

Pediatric EM Morsels

JUNE 16, 2023

Sometimes this can be used to our advantage, like when we need to give subcutaneous fluids to a dehydrated patient without an IV, or when we need to give SQ medications for things like Sulfonylurea overdose , Hereditary Angioedema , or DVTs. Shen 2013, Nickerson 2014, Scolaro 2016 ] Singh et al proposed an algorithm to guide treatment.

Overdose 152

Overdose OR Critical Care ALS 152

SSCOR

JUNE 29, 2024

In 2021, fires killed 4,316 Americans , and over the past 10 years, fire deaths have increased by almost 18%. Most die not from burns but from oxygen deprivation caused by smoke inhalation. Immediate survivors of the blaze are not out of the woods. The consequences of smoke inhalation can show up hours or even days later.

OR 84

OR 84

The Skeptics' Guide to EM

JANUARY 8, 2022

Date: December 28th, 2021 Reference: Kulvatunyou et al. November 2021. Date: December 28th, 2021 Reference: Kulvatunyou et al. November 2021. November 2021. The small (14 Fr) percutaneous catheter (P-CAT) versus large (28–32 Fr) open chest tube for traumatic hemothorax: A multicenter randomized clinical trial.

ALS 130

ALS Emergency Department Paramedic OR 130

Core EM

MARCH 12, 2024

Author: Mallika Singh, MD Editor: Jonathan Kobles, MD Background Unintentional or intentional exposure to radiological material represents a potential threat to human health on the individual to mass-casualty scale. Radioactive sources include medical isotopes, fuel rods, generators, and other industrial sources. 10-Hour Flight: 0.03

ALS 130

ALS OR Emergency Department ED 130

ALiEM

SEPTEMBER 11, 2023

2021 Apr;44(2):330-367. Epub 2021 Mar 25. 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. No foreign body on lid eversion. CLEAR – Contact lens complications.

Emergency Department 152

Emergency Department ED OR 152

ALiEM

MARCH 1, 2024

McGraw Hill; 2021. Resp : Clear to auscultation bilaterally. Abd : Soft, non-tender, non-distended. Neuro : Alert. Motor and sensation grossly intact. MSK : Moves all extremities, no joint pain or tenderness. Skin : No obvious rashes or skin lesions. This is traumatic iridodialysis. References Knoop KJ, Palma JK. Iridodialysis.

ED 152

ED OR 152

The Skeptics' Guide to EM

JANUARY 1, 2022

Date: December 21st, 2021 Guest Skeptic: Dr. Howard “Howie” Mell began his career as a firefighter / paramedic in Chicago. NEJM 2021 […] The post SGEM#354: Everybody Walk the Dinosaur and Not Take the MSU first appeared on The Skeptics Guide to Emergency Medicine. Howie also has a Master of Public Health. Reference: Grotta JC et al.

Emergency Medical Services 130

Emergency Medical Services Firefighter Paramedic ALS 130

The Skeptics' Guide to EM

SEPTEMBER 18, 2021

Date: September 16th, 2021 Reference: Sippola et al. JAMA 2021 Guest Skeptic: Dr. Rob Leeper is an assistant professor of surgery at Western University and the London Health Sciences Center. Date: September 16th, 2021 Reference: Sippola et al. The APPAC II Randomized Clinical Trial. The APPAC II Randomized Clinical Trial.

ALS 130

ALS Critical Care OR 130

The Skeptics' Guide to EM

AUGUST 21, 2021

Date: August 19th, 2021 Reference: Pantell et al. Pediatrics 2021 Guest Skeptic: Dr. Dennis Ren is a pediatric emergency medicine fellow at Children’s National Hospital in Washington, DC. Date: August 19th, 2021 Reference: Pantell et al. Evaluation and management of well-appearing febrile infants 8 to 60 days old.

Emergency Department 130

Emergency Department ALS OR ED 130

The Skeptics' Guide to EM

SEPTEMBER 11, 2021

Date: September 8th, 2021 Reference: Desch et al. Date: September 8th, 2021 Reference: Desch et al. The TOMAHAWK Investigators. Angiography after Out-of-Hospital Cardiac Arrest without ST-Segment Elevation. first appeared on The Skeptics Guide to Emergency Medicine. The TOMAHAWK Investigators.

EMR 130

EMR Coronary Defibrillator Life Support 130

EMDocs

DECEMBER 19, 2023

McGraw Hill; 2021. McGraw Hill; 2021. Possible early antibiotic treatment Minor Marine Trauma Mechanism: Bites, Stings, Nematocysts Envenomation Presentation: All can cause localized pain, erythema, and warmth Dermatologic: Urticaria, burning, pruritus, localized paresthesia. Marine Trauma and Envenomation. Accessed August 25, 2022.

First Aid 92

First Aid ED OR ALS 92

The Skeptics' Guide to EM

NOVEMBER 6, 2021

Date: November 1st, 2021 Reference: Katsanos et al. Neurology 2021 Guest Skeptic: Dr. Michal Krawczyk is in his fifth year of neurology residency at Western University in London, Ontario, Canada. Date: November 1st, 2021 Reference: Katsanos et al. first appeared on The Skeptics Guide to Emergency Medicine.

ALS 130

ALS OR 130

Don't Forget the Bubbles

AUGUST 19, 2024

Clinical Practice Guideline by the Pediatric Infectious Diseases Society and the Infectious Diseases Society of America: 2021 Guideline on Diagnosis and Management of Acute Hematogenous Osteomyelitis in Pediatrics. 2021 Sep 23;10(8):801-844. He points to his sternum when you ask him where the pain is. MRI is superior to CXR.

Emergency Department 101

Emergency Department OR 101

ALiEM

AUGUST 18, 2023

Copyright Images and cases from the Society of Academic Emergency Medicine (SAEM) Clinical Images Exhibit at the 2021 SAEM Annual Meeting | Copyrighted by SAEM 2021 – all rights reserved. Case Question: What are the most common etiologies of the diagnosis? Oman J Ophthalmol. 2016 May-Aug;9(2):80-6. doi: 10.4103/0974-620X.184509.

Emergency Department 130

Emergency Department OR 130

The Skeptics' Guide to EM

FEBRUARY 27, 2021

Date: February 18th, 2021 Guest Skeptic: Dr. Chris Bond is an emergency medicine physician and assistant Professor at the University of Calgary. Date: February 18th, 2021 Guest Skeptic: Dr. Chris Bond is an emergency medicine physician and assistant Professor at the University of Calgary. AEM Feb 2021. AEM Feb 2021.

Emergency Department 130

Emergency Department ALS ACS ED 130

The Skeptics' Guide to EM

JANUARY 23, 2021

Date: January 20th, 2021 Guest Skeptic: Dr. Lauren Westafer an Assistant Professor in the Department of Emergency Medicine at the University of Massachusetts Medical School – Baystate. AEM January 2021 Case: A 50-year-old male presents to the Emergency Department (ED) with left lower quadrant abdominal pain.

ED 130

ED ALS Emergency Department OR 130

Core EM

JANUARY 25, 2024

Patients in this trial were on relatively low doses of both dexmedetomidine and propofol and higher doses of fentanyl which may limit the ability to adequately compare the two agents well ( Hughes 2021 ). μg/kg IV Maintenance dose: 0.5 – 15 μg/kg/hr Rapid onset. Short acting. Not affected by hepatic or renal failure.

Emergency Department 246

Emergency Department ICU Critical Care ALS 246

Dr. Smith's ECG Blog

DECEMBER 5, 2023

2021 Aug 10;144(6):e123-e135. Epub 2021 Jul 7. 2021 Aug 10;144(6):e149. 2021 Apr 18;13(4):700. 2021 Aug;17(4):335-340. 2021 Aug;17(4):335-340. Epub 2021 May 20. The pain was described as constant, worse with deep inspiration and physical activity, sometimes sharp. He denied drug or alcohol use.

Coronary 115

Coronary CAD ACS ALS 115