Dr. Smith's ECG Blog

DECEMBER 27, 2023

The original term " benign early repolarization" has fallen out of favor since the seminal paper by Haïssaguerre et al. Smith's ECG Blog — with detailed description of this entity in the May 23, 2022 post by Dr. McLaren ( Please check out My Comment and illustrative Figure at the bottom of the page of this post ). link] Lupu, L.,

E-9-1-1 116

E-9-1-1 OR Coronary ACS 116

Pediatric EM Morsels

NOVEMBER 3, 2023

More specifically they have seen this trend continue to rise in the era of post-COVID travel (Choy 2022). Another change is the CDC approved the use of IV artesunate for malaria treatment in the US in May 2022. WHO 2022) In a previous PEM morsel, we mentioned Sickle Cell Trait is only protective against P. falciparum.

ALS 278

ALS Critical Care EMS OR 278

ALiEM

OCTOBER 11, 2023

Hassoun AER, Ujević I, Jemaa S et al. 2022 Feb 8;14(2):123. Treasure Island (FL): StatPearls Publishing; August 8, 2022. Alhatali B, Al Lawatia S, Khamis F, Kantur S, Al-Abri S, Kapil V, Thomas J, Johnson R, Hamelin EI, Coleman RM, Kazzi Z. 2022 Feb;60(2):262-266. 2022 Nov 8;19(22):146-8.

E-9-1-1 204

E-9-1-1 ALS OR 204

ALiEM

JUNE 5, 2023

Human illness is most commonly acquired by handling animal fluids or pelts. There are several forms of anthrax, however cutaneous is the most common (95% of cases) and the least complicated to treat [2]. What are the symptoms of cutaneous anthrax? [3, 3, 4] Naturally occurring cases develop after spores of B. Is cutaneous anthrax reportable? [6,

ALS 256

ALS OR ED 256

The Skeptics' Guide to EM

SEPTEMBER 9, 2023

Reference: Snelling et al. Reference: Snelling et al. Reference: Snelling et al. Ultrasonography or radiography for suspected pediatric distal forearm fractures. He is also a fully-fledged ultrasonographer. Ultrasonography or radiography for suspected pediatric distal forearm fractures.

Critical Care 310

Critical Care ALS ED Emergency Department 310

Broome Docs

OCTOBER 31, 2022

2022 Jan;48(1):78-91. 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. 2022 Sep 15;387(11):989-1000. 2022 Sep 18.

E-9-1-1 52

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

Don't Forget the Bubbles

OCTOBER 2, 2024

Kochanek et al… Kochanek PM, Tasker RC, Carney N, Totten AM, Adelson PD, Selden NR, et al. There was also a meta-analysis on this topic in the adult population by Schwimmbeck et al [6] in 2021. Pediatric Critical Care Medicine. They received 2494 boluses of either mannitol or 3% hypertonic saline. 2023 [cited 2024 Apr 10].

OR 49

OR Critical Care ALS Emergency Department 49

Dr. Smith's ECG Blog

SEPTEMBER 18, 2024

Studies such as those by Moise et al 14 and Ellis et al 39 have shown that the relative risk of developing an acute myocardial infarction in the territory supplied by an artery with a 70%. Thus, the lumen observed may actually still be the same size as the original, normal lumen. Nor was there a challenge to look for coronary spasm.

Coronary 115

Coronary ACS OR EMR 115

Core EM

JANUARY 25, 2024

source: “Thrombotic Thrombocytopenic Purpura (TTP)”, 2022 , National Heart, Lung, and Blood Institute. An example of petechiae and purpura frequently seen with thrombocytopenic disorders. 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

Pediatric EM Morsels

OCTOBER 27, 2023

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 Reduces dosing errors during resus, up to 33.88%. Recommended by ATLS and PALS. Krug 2007] What If the Child is Obese or Emaciated?

E-9-1-1 269

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

Pediatric EM Morsels

JULY 21, 2023

Jain 2022] Now used for critically ill trauma and medical patients in >75 countries. Jain 2022] Now used for critically ill trauma and medical patients in >75 countries. Jain 2022] Glasgow Coma Scale in Children – How do you perform it correctly? When is it useful and what does it tell us?

Critical Care 246

Critical Care ALS OR Life Support 246

ALiEM

FEBRUARY 5, 2024

Reference Lin M, Phipps M, Chan TM, et al. These posts have been flagged by and agreed upon by AIR Board members as worthwhile, accurate, unbiased, and appropriately referenced despite an average score. Please go to the above link. You will need to create a free, 1-time login account. Ann Emerg Med. 2023;82(1):55-65.

Overdose 215

Overdose Critical Care EMS Emergency Department 215

ALiEM

OCTOBER 14, 2023

Reference Lin M, Phipps M, Chan TM, et al. These posts have been flagged by and agreed upon by AIR Board members as worthwhile, accurate, unbiased, and appropriately referenced despite an average score. Please go to the above link. You will need to create a free, 1-time login account.

Critical Care 169

Critical Care EMS Emergency Department ALS 169

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. Reversal of Warfarin: Freeman et al. Reversal of Warfarin: Freeman et al. Blood Pressure Control: There is a lot of debate about the aggressiveness of blood pressure lowering.

Emergency Medical Services 176

Emergency Medical Services ALS Emergency Department ED 176

Core EM

JANUARY 25, 2024

Lipophilic with adipose deposition, withdrawal symptoms after prolonged infusion Hydromorphone 5 – 15 min 2 – 3 hr 0.5 – 3 mg/hr No active metabolites however parent drug can accumulate in renal failure Morphine 5 – 10 min 3 – 4 hr 2 – 30 mg/hr Active metabolites can accumulate in renal failure Remifentanil 1 – 3 min 3 – 10 min Loading dose: 1.5

ICU 246

ICU Emergency Department Critical Care ALS 246

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. Reference: de-Madaria E et al. Aggressive or Moderate Fluid Resuscitation in Acute Pancreatitis (WATERFALL). Guest Skeptic: Dr. Salim R. Guest Skeptic: Dr. Salim R.

ALS 130

ALS Emergency Department OR EMS 130

Broome Docs

AUGUST 2, 2022

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. 2022 Jan;175(1):20-28. Le Gal G, Kovacs MJ, Bertoletti L, et al. 2022 Jan;175(1):29-35. 2022 May 1;176(5):486-492.

ED 52

ED Emergency Department ALS Critical Care 52

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. The Relative Efficacy of Seven Skeletal Muscle Relaxants.

ALS 130

ALS Emergency Department 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

ALiEM

MARCH 11, 2024

In July 2022, a 32-year-old male with a past medical history of HIV (on antiretroviral therapy, CD4 390, viral load undetectable) presented to the emergency department with constitutional symptoms and a rash for 4-5 days. Epub 2022 Jul 27. The 2022 outbreak and the pathobiology of the monkeypox virus. 2022 Jul;131:102855.

Emergency Department 141

Emergency Department ALS OR 141

Pediatric EM Morsels

JULY 28, 2023

Glucose > 200 mg/dL Moderate or Large Ketonuria The severity of DKA is categorized by the degree of acidosis Mild : venous pH < 7.3 or serum bicarbonate between 11-17 mmol/L Moderate : venous pH < 7.2 or serum bicarbonate between 5-10 mmol/ L Severe : venous pH < 7.1 Neuroimaging is NOT required. GCS score is not sensitive enough.

E-9-1-1 246

E-9-1-1 ALS OR Critical Care 246

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

JANUARY 6, 2024

Reference: Remick KE, et al. Reference: Remick KE, et al. Background: Back in August of 2022, we announced the start of #SGEMPeds for SGEM Season 11. Reference: Remick KE, et al. National Assessment of Pediatric Readiness of US Emergency Departments during the Covid-19 Pandemic. JAMA Netw Open. JAMA Netw Open.

Emergency Department 261

Emergency Department Emergency Medical Services ALS ED 261

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. The evidence had a substantial amount of heterogeneity (3).

Emergency Department 130

Emergency Department ALS ED OR 130

REBEL EM

MAY 25, 2023

mental status, urine output, capillary refill) is more important than an actual goal PERMISSIVE HYPOTENSTION IN PTS WITH TBI Brotfain E et al. mental status, urine output, capillary refill) is more important than an actual goal PERMISSIVE HYPOTENSTION IN PTS WITH TBI Brotfain E et al. Richards JE et al. NEJM 1994. [2]

E-9-1-1 145

E-9-1-1 Plasma ALS OR 145

The Skeptics' Guide to EM

OCTOBER 22, 2022

Date: October 18th, 2022 Reference: Moore et al. Resuscitation 2022 Guest Skeptic: Clay Odell is a Paramedic, Firefighter, and registered nurse (RN). Date: October 18th, 2022 Reference: Moore et al. Resuscitation 2022 Guest Skeptic: Clay Odell is a Paramedic, Firefighter, and registered nurse (RN).

CPR 130

CPR Defibrillator Epinephrine Firefighter 130

EMDocs

NOVEMBER 13, 2024

Literature concerning risk with PPIs is controversial. Presentation: Classic presentation is abdominal pain or tenderness, fever, and altered mental status. Literature suggests 10-33% of patients are asymptomatic or only have mild symptoms. Clinician sensitivity for SBP based on bedside assessment is between 40-75%. increase in mortality.

E-9-1-1 71

E-9-1-1 ALS OR ED 71

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

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. Brown et al , Selbst and Clark ). Reference: Hartford et al. AEM September 2022. The headache is similar to prior migraine headaches.

Emergency Department 130

Emergency Department ALS 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. Reference: Kim et al. AEM February 2022. She is […] The post SGEM#360: We Care a Lot – The EmPATH Study first appeared on The Skeptics Guide to Emergency Medicine.

ED 130

ED ALS Emergency Department 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]. Spinal shock is a phenomenon of transient, physiologic (rather than anatomic) complete loss of spinal cord function inferior to an injury. Moral of the Morsel Anatomy Matters!

E-9-1-1 300

E-9-1-1 Epinephrine ALS EMS 300

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

JANUARY 7, 2023

Date: January 4th, 2023 Reference: Hasbrouck et al. Date: January 4th, 2023 Reference: Hasbrouck et al. AJEM 2022 Guest Skeptics: Dr. Timlin Glaser currently a fourth-year resident in emergency medicine at Lehigh Valley Health Network and future medical toxicology fellow at the University of Arizona College of Medicine – Phoenix.

Emergency Department 100

Emergency Department OR ALS Ambulance 100

Pediatric EM Morsels

JUNE 2, 2023

Allergy Asthma Clin Immunol 18, 54 (2022). Rare diseases are not confined to the pages of a textbook or computer screen. Our patients have varied past medical histories that require us to be well-versed in even the most uncommon disorders (or know where to look things up in a pinch)! J Asthma Allergy. 2017 Jun 27;10:197-207.

Emergency Department 189

Emergency Department ALS EMS OR 189

The Skeptics' Guide to EM

JUNE 12, 2022

Date: June 12th, 2022 Reference: Finfer et al. Date: June 12th, 2022 Reference: Finfer et al. Reference: Finfer et al. Balanced Multielectrolyte Solution versus Saline in Critically Ill Adults. Balanced Multielectrolyte Solution versus Saline in Critically Ill Adults. Early work suggested potential harm from 0.9%

ICU 132

ICU Plasma Critical Care ALS 132

ALiEM

NOVEMBER 3, 2023

Reference Lin M, Phipps M, Chan TM, et al. These posts have been flagged by and agreed upon by AIR Board members as worthwhile, accurate, unbiased, and appropriately referenced despite an average score. Please go to the above link. You will need to create a free, 1-time login account. Ann Emerg Med. 2023;82(1):55-65.

Critical Care 211

Critical Care Emergency Department EMS ALS 211

Broome Docs

OCTOBER 6, 2024

Turgeon AF, Fergusson DA, Clayton L,et al. doi: 10.1136/emermed-2022-213000. PMID: 38238065 Oral vs IV ABs… another negative trial Nielsen AB, Holm M, Lindhard MS, et al. So follow along with the papers below and read to make up your own mind about the evidence presented. Too much ‘aint enough blood? N Engl J Med.

Critical Care 112

Critical Care ALS Emergency Department EMS 112