Dr. Smith's ECG Blog

OCTOBER 27, 2024

The cath lab was deactivated by cardiologist on arrival at ED because it was "not a STEMI". He presented to the ED for evaluation chest pain. It was in his central and left chest, radiated to his left arm, and he experienced some cold sweats and nausea prompting him to call 911 and he was brought to ED via ambulance. Lupu et al.

STEMI 119

STEMI ED Coronary EMS 119

The Skeptics' Guide to EM

SEPTEMBER 9, 2023

Reference: Snelling et al. Reference: Snelling et al. Casey currently splits his time between Broome, a small rural hospital in the remote Kimberley region of Western Australia, and a large tertiary ED in sunny Perth. Case: It is a steady Saturday afternoon in your rural emergency department (ED).

Critical Care 310

Critical Care ALS ED Emergency Department 310

REBEL EM

JANUARY 25, 2024

In many emergency departments (ED), US machines are readily available and can be used to rapidly assess and monitor patients with acute dyspnea at the bedside. Article: Arvig MD, Lassen AT, Gæde PH, et al. US, compared with CXR and CT, offers the absence of ionizing radiation and high reproducibility. Emerg Med J. 2023;40(10):700-707.

ED 130

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

The Skeptics' Guide to EM

JANUARY 6, 2024

Reference: Remick KE, et al. Reference: Remick KE, et al. Case: After your shift in the emergency department (ED) one day, the medical director pulls you aside. Background: Back in August of 2022, we announced the start of #SGEMPeds for SGEM Season 11. Reference: Remick KE, et al. JAMA Netw Open. JAMA Netw Open.

Emergency Department 261

Emergency Department Emergency Medical Services ALS ED 261

ACEP Now

JUNE 7, 2023

The performance of EDs in 2020 and into 2021 changed abruptly, and that carried through into 2022. EDs weathered attacks from a variety of sources in recent years. ED leaders worked to develop new physician documentation and coding guidelines that needed to be implemented at the beginning of 2023.

Emergency Department 52

Emergency Department ED EMS Ambulance 52

Broome Docs

AUGUST 2, 2022

This one is a bit epic and we start with a really important discussion around diagnostic strategies for palliative patients in the ED. Vitamin C in sepsis: STOP IT, we do not LOVE IT Lamontagne F, Masse MH, Menard J, et al; LOVIT Investigators and the Canadian Critical Care Trials Group. 2022 Jun 23;386(25):2387-2398.

ED 52

ED Emergency Department ALS Critical Care 52

The Skeptics' Guide to EM

OCTOBER 1, 2022

Date: September 28th, 2022 Reference: Hartford et al. AEM September 2022. Date: September 28th, 2022 Reference: Hartford et al. AEM September 2022. Patients with migraines often present to the ED looking for pain relief. Brown et al , Selbst and Clark ). Reference: Hartford et al.

Emergency Department 130

Emergency Department ALS ED OR 130

Core EM

JANUARY 25, 2024

Background: The immediate post intubation period in the ED is a critical time for continued patient stabilization. The reality of ever increasing ED volumes and longer boarding times to the ICU makes it imperative for emergency physicians to learn how to manage these critical patients.

ICU 246

ICU Emergency Department Critical Care ALS 246

The Skeptics' Guide to EM

AUGUST 10, 2024

Date: July 29, 2024 Reference: Connolly SJ et al (ANNEXA-I investigators) Andexanet for Factor Xa Inhibitor–Associated Acute Intracerebral Hemorrhage. Case: A 65-year-old man is brought into the emergency department (ED) by emergency medical services (EMS) after his family saw him slump over at the dinner table.

Emergency Medical Services 176

Emergency Medical Services ALS Emergency Department ED 176

The Skeptics' Guide to EM

APRIL 2, 2022

Date: March 31st, 2022 Reference: Butt et al. AEM March 2022 Guest Skeptic: Dr. Lauren Westafer is an Assistant Professor in the Department of Emergency Medicine at the University of Massachusetts Medical School – Baystate. Date: March 31st, 2022 Reference: Butt et al. Reference: Butt et al.

Emergency Department 130

Emergency Department ALS ED OR 130

The Skeptics' Guide to EM

MAY 14, 2022

Date: May 13th, 2022 Reference: Abril et al. J Emerg Med 2022 Guest Skeptic: Dr. Sergey Motov is an Emergency Physician in the Department of Emergency Medicine, Maimonides Medical Center in New York City. Date: May 13th, 2022 Reference: Abril et al. EDs annually (1). His twitter handle is @PainFreeED.

ALS 130

ALS Emergency Department ED OR 130

The Skeptics' Guide to EM

FEBRUARY 26, 2022

Date: February 21st 2022 Reference: Kim et al. AEM February 2022. Date: February 21st 2022 Reference: Kim et al. AEM February 2022. You wonder whether a model of care involving a specifically designed unit would improve their patient experience and ED boarding times. Reference: Kim et al.

ED 130

ED ALS Emergency Department OR 130

The Skeptics' Guide to EM

SEPTEMBER 10, 2022

Date: August 25th, 2022 Reference: Martin et al. 2022 Guest Skeptic: Dr. Harrison Hayward is a Pediatric Emergency Medicine fellow at Children’s National Hospital. Date: August 25th, 2022 Reference: Martin et al. Reference: Martin et al. Pediatr Emerg Care. Pediatr Emerg Care. Pediatr Emerg Care.

Emergency Department 130

Emergency Department ALS ED OR 130

Broome Docs

DECEMBER 9, 2023

Is it a good idea to keep geriatric patients in the ED overnight? Are you being irradiated by the portable Xray machines in your ED? Roussel M, Teissandier D, Yordanov Y, et al. 2022 Nov;63(5):645-650. Epub 2022 Oct 12. PMID: 36755492 Freeman JJ, Asfaw SH, Vatsaas CJ, et al. 2022 Oct 25;7(1):e000886.

Emergency Department 120

Emergency Department ALS ED 120

ALiEM

JUNE 5, 2023

ED providers are only exposed in these cases if they have direct contact with drainage from open wounds while not using PPE or there is concern for aerosolization of spores For inhalational anthrax exposure, AVA should be given in combination with antimicrobials (ciprofloxacin or doxycycline) for 60 days. Updated 2022 Jul 26].

ALS 256

ALS OR ED 256

ALiEM

FEBRUARY 5, 2024

Reference Lin M, Phipps M, Chan TM, et al. You will need to create a free, 1-time login account. Digital Impact Factor: A Quality Index for Educational Blogs and Podcasts in Emergency Medicine and Critical Care. Ann Emerg Med. 2023;82(1):55-65. doi: 10.1016/j.annemergmed.2023.02.011

Overdose 215

Overdose Critical Care EMS Emergency Department 215

ALiEM

OCTOBER 14, 2023

Reference Lin M, Phipps M, Chan TM, et al. Digital Impact Factor: A Quality Index for Educational Blogs and Podcasts in Emergency Medicine and Critical Care.

Critical Care 169

Critical Care EMS Emergency Department ALS 169

The Skeptics' Guide to EM

JULY 30, 2022

Date: July 28th, 2022 Reference: Brower et al. AEM July 2022 Guest Skeptic: Dr. Kirsty Challen is a Consultant in Emergency Medicine at Lancashire Teaching Hospitals. Date: July 28th, 2022 Reference: Brower et al. Reference: Brower et al. She is also the creator of all those wonderful Paper in a Pictures.

ALS 130

ALS ED Emergency Department EMS 130

The Skeptics' Guide to EM

DECEMBER 10, 2022

Date: November 30th, 2022 Reference: Johnson et al. Date: November 30th, 2022 Reference: Johnson et al. Bone Joint J 2022 Guest Skeptic: Dr.Matt Schmitz is an Orthopaedic Surgeon specializing in Adolescent Sports Medicine and Young Adult Hip Preservation. He asks if surgery would be a better option?

Emergency Department 130

Emergency Department ALS ED OR 130

ALiEM

NOVEMBER 29, 2023

PMID: 34529640 Ayub S, Parnia S, Poddar K, et al. PMID: 24769343 Ehrman-Dupre R, Kaigh C, Salzman M et al. Journal of Addiction Medicine 16(5):p 595-598, 9/10 2022. Published 2022 Aug 19. PMID: 36148197 Love JS, Levine M, Aldy K, et al. PMID: 37014353 Ball NS, Knable BM, Relich TA et al. Forensic Sci Int.

Naloxone 169

Naloxone Overdose ALS Epinephrine 169

The Skeptics' Guide to EM

AUGUST 27, 2022

Date: August 23rd, 2022 Reference: Schoenfeld et al. Just give them a choice”: Patients’ perspectives regarding starting medications for opioid use disorder in the ED. AEM August 2022 Guest Skeptic: Dr. Chris Bond is an emergency medicine physician and assistant Professor at the University of Calgary.

Emergency Department 100

Emergency Department Naloxone Overdose ED 100

The Skeptics' Guide to EM

JANUARY 14, 2023

Date: January 13, 2023 Reference: Razi et al. AJEM 2022 Guest Skeptic: Dr. Kevan Sternberg is a urologist/endourologist. Date: January 13, 2023 Reference: Razi et al. AJEM 2022 Guest Skeptic: Dr. Kevan Sternberg is a urologist/endourologist. Reference: Razi et al.

ALS 130

ALS Emergency Department ED OR 130

The Skeptics' Guide to EM

DECEMBER 17, 2022

Date: December 16th, 2022 Reference: Hohle et al. AEM December 2022 Guest Skeptic: Dr. Kirsty Challen is a Consultant in Emergency Medicine at Lancashire Teaching Hospitals. Date: December 16th, 2022 Reference: Hohle et al. years ( 2 ).

Frozen Plasma 130

Frozen Plasma FFP Emergency Medical Services Plasma 130

Pediatric EM Morsels

OCTOBER 27, 2023

Sinha 2012] It is useful in the prehospital setting , correlating well with actual weight and ED Broselow weight. PAWPER [Wells 2013, Silvagni 2022] Takes into account body habitus. Zhu 2022] In Nepalese children, the Broselow correlated well at lower weights, but accuracy decreased at higher weights >18 kg. [K x exp[0.02

E-9-1-1 269

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

The Skeptics' Guide to EM

OCTOBER 8, 2022

Date: September 15, 2022 Reference: Ramnarayan P et al. JAMA July 2022 Guest Skeptic: Dr. Spyridon Karageorgos is a Pediatric Resident at Aghia Sophia […] The post SGEM #379 Heigh Ho High Flow versus CPAP in Acutely Ill Children first appeared on The Skeptics Guide to Emergency Medicine. In 2018, Ramnarayan et al.

Critical Care 130

Critical Care ALS Emergency Department ED 130

The Skeptics' Guide to EM

NOVEMBER 12, 2022

Date: November 10th, 2022 Reference: de-Madaria E et al. Date: November 10th, 2022 Reference: de-Madaria E et al. Case: A 38-year-old male presents to the emergency department (ED) with acute mid epigastric abdominal pain with nausea and vomiting. Reference: de-Madaria E et al. Guest Skeptic: Dr. Salim R.

ALS 130

ALS Emergency Department OR EMS 130

Don't Forget the Bubbles

NOVEMBER 6, 2024

Catassi G, et al. Marciano L, et al. Rao CK, et al. Hale L, et al. Vaičiūnas T, et al. Oberbaum M, et al. Tahir OE, et al. Jones H, et al. Vanhelst J, et al. Shadbegian R, et al. LeBlanc TT, et al. Gibbs AAM, et al. Synnes A, et al. Edwards EM, et al.

ALS 59

ALS ED OR EMS 59

EMDocs

JUNE 3, 2023

The nuances of fracture patterns and delineating mechanically unstable pelvic fractures from stable ones is less important to the ED. This is less critical in ED management of the unstable pelvic fracture, as the optimal site for identification of rectal or vaginal tears is the operating room.

ED 54

ED Operating Room ALS Frozen Plasma 54

The Skeptics' Guide to EM

FEBRUARY 5, 2022

Date: February 7th, 2022 Reference: Williams et al. JAMA Pediatrics 2022 Guest Skeptic: Dr. Dennis Ren is a pediatric emergency medicine fellow at Children’s National Hospital in Washington, DC. Date: February 7th, 2022 Reference: Williams et al. Reference: Williams et al.

Emergency Department 130

Emergency Department ALS ED OR 130

Pediatric EM Morsels

SEPTEMBER 22, 2023

Tenenbein M, Macias CG, Sharieff GQ, et al, eds. Updated 2022 Feb 10]. Tenenbein M, Macias CG, Sharieff GQ, et al, eds. Updated 2022 Mar 3]. They may even need atropine and/or pacing for persistent bradycardia. References Coleman-Satterfield, TT. In: Strange and Schafermeyer’s: Pediatric Emergency Medicine.

E-9-1-1 300

E-9-1-1 Epinephrine ALS EMS 300

Core EM

JANUARY 25, 2024

1 2 3 4 This article will focus on three lower extremity (LE) nerve blocks commonly used for acute lower extremity pain in the ED. link] [3] Morrison RS, Magaziner J, Gilbert M, et al. Door-to-block time: prioritizing acute pain management for femoral fractures in the ED. Published February 4, 2022. 2003;58(1):76-81.

Epinephrine 246

Epinephrine ED OR Emergency Department 246

The Skeptics' Guide to EM

FEBRUARY 18, 2023

Date: February 17, 2023 Reference: Gettel et al. Date: February 17, 2023 Reference: Gettel et al. Case: You are an administrator responsible for staffing emergency departments (EDs) in a health care system comprising both urban and rural locales. The SGEM has done two previous podcasts on APPs in the ED.

Emergency Department 130

Emergency Department ALS ED EMS 130

The Skeptics' Guide to EM

JULY 2, 2022

Date: June 30th, 2022 Reference: McGinnis et al. AEM June 2022. Date: June 30th, 2022 Reference: McGinnis et al. AEM June 2022. Case: You are working a shift in your local community emergency department (ED) when a 47-year-old male presents with chest pain. If we thought about ACS, we brought them in.

Coronary 100

Coronary Heart Attack ACS CAD 100

The Skeptics' Guide to EM

JANUARY 29, 2022

Date: January 25th, 2022 Reference: Beyde et al. AEM January 2022 Guest Skeptic: Dr. Corey Heitz is an emergency physician in Roanoke, Virginia. Date: January 25th, 2022 Reference: Beyde et al. AEM January 2022 Guest Skeptic: Dr. Corey Heitz is an emergency physician in Roanoke, Virginia.

Emergency Department 130

Emergency Department ALS ED 130

The Skeptics' Guide to EM

JUNE 12, 2022

Date: June 12th, 2022 Reference: Finfer et al. Date: June 12th, 2022 Reference: Finfer et al. Two large, cluster-randomized trials ( SMART and SALT-ED ) showed a small benefit to the use of balanced crystalloids in preventing a composite outcome of Major Adverse Kidney Events within 30 days (aka MAKE-30).

ICU 132

ICU Plasma Critical Care ALS 132

The Skeptics' Guide to EM

JUNE 18, 2022

Date: June 18th, 2022 Reference: Crombie et al. The Lancet Haematology 2022 Guest Skeptic: Dr. Casey Parker is a Rural Generalist that includes in his practice emergency medicine, anaesthesia and critical care. Date: June 18th, 2022 Reference: Crombie et al. Reference: Crombie et al. What do you advise him?

Plasma 100

Plasma Critical Care Paramedic ALS 100

REBEL EM

MAY 20, 2024

A 67-year-old woman with a history of atrial fibrillation on apixaban presents to the ED for epistaxis that began 30 minutes ago. Post TW, ed. Accessed July 19, 2022. In: Tintinalli JE, Ma OJ, Yealy DM, et al., In: Tintinalli JE, Ma OJ, Yealy DM, et al., Her vital signs are within normal limits. UpToDate Inc.

ALS 59

ALS ED EMS 59