Dr. Smith's ECG Blog

SEPTEMBER 3, 2023

This was sent by anonymous The patient is a 55-year-old male who presented to the emergency department after approximately 3 to 4 days of intermittent central boring chest pain initially responsive to nitroglycerin, but is now more constant and not responsive to nitroglycerin. It is unknown when this pain recurred and became constant.

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Defibrillator Coronary STEMI CPR 131

Dr. Smith's ECG Blog

DECEMBER 27, 2023

Written by Willy Frick A man in his 50s with a history of hypertension, dyslipidemia, type 2 diabetes mellitus, and prior inferior OMI status post DES to his proximal RCA 3 years prior presented to the emergency department at around 3 AM complaining of chest pain onset around 9 PM the evening prior. Circulation, 104(6), 636–641.

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E-9-1-1 OR Coronary ACS 117

Dr. Smith's ECG Blog

APRIL 18, 2024

Written by Jesse McLaren A 70 year old with prior MIs and stents to LAD and RCA presented to the emergency department with 2 weeks of increasing exertional chest pain radiating to the left arm, associated with nausea. 1] European guidelines add "regardless of biomarkers". But only 6.4% Eur Heart J Digital Health 2024 5.

STEMI 119

STEMI Coronary ALS CAD 119

Dr. Smith's ECG Blog

JANUARY 27, 2024

, tells us that we physicians do not need to even look at this ECG until the patient is placed in a room because the computer says it is normal: Validity of Computer-interpreted “Normal” and “Otherwise Normal” ECG in Emergency Department Triage Patients I reviewed this article for a different journal and recommended rejection and it was rejected.

STEMI 102

STEMI Coronary ACS ED 102

ACEP Now

MARCH 14, 2024

A 44 year-old male with unknown past medical history came by emergency medical services (EMS) to the emergency department (ED) for an electrical injury and fall from a high voltage electrical pole. 2,3,5 Except for laundry or electrical car outlets (240 V AC), all U.S. household outlets are rated at 120 V AC.

Operating Room 52

Operating Room ACS Critical Care Coronary 52

Don't Forget the Bubbles

JUNE 30, 2023

Interim results presented earlier this year show that REBOA performed within the Emergency Department increased mortality. b) Emergency thoracotomy Let’s be clear: YOU will not be doing any of this. Interim results presented earlier this year show that REBOA performed within the Emergency Department increased mortality.

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E-9-1-1 FFP Plasma Emergency Department 139

ACEP Now

AUGUST 12, 2024

A 35-year-old male presented to the emergency department complaining of chest pain that started 1.5 5 Studies looking at this phenomenon in the emergency department setting for patients presenting with chest pain are lacking. Dr. Young is an emergency physician at Saint Francis Hospital and Medical Center, Hartford, Conn.

Emergency Department 52

Emergency Department STEMI ACS ED 52

EMDocs

JUNE 27, 2024

Am J Emerg Med. Chinawa JM, Ubesie AC, Chukwu BF, Ikefuna AN, Emodi IJ. Epub 2023 Nov 27. Intranasal fentanyl and discharge from the emergency department among children with sickle cell disease and vaso-occlusive pain: A multicenter pediatric emergency medicine perspective. 2023 Apr;98(4):620-627.

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E-9-1-1 ICU ACS EMS 76

Don't Forget the Bubbles

OCTOBER 2, 2024

Children often spend many hours in the emergency department (ED) before being sent home or admitted. In this issue of Pediatrics , Leyenaar and colleagues reported on a trial to compare the effectiveness of direct admission to bypass their emergency departments. 2024 Sep 19:archdischild-2023-326507. Räty S, et al.

ALS 52

ALS Emergency Department ED ACS 52

EMDocs

OCTOBER 21, 2023

The NIHSS cutoff that predicts outcomes is 4 points higher in AC compared with PC infarctions. Reference article,   Radiopaedia.org (Accessed on 15 Apr 2023) [link] Mattle HP, Arnold M, Lindsberg PJ, Schonewille WJ, Schroth G: Basilar artery occlusion. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Lancet Neurol.

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EMS ALS OR ACS 75

Dr. Smith's ECG Blog

OCTOBER 25, 2023

A man in his 60s with a history of severe alcohol use disorder and epidural abscess on long-term ciprofloxacin presented to the emergency department after an episode of syncope while standing in line at a grocery store. Moreover, the Queen is only supposed to be used with a high pretest probability of ACS/OMI.

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Overdose OR ACS ICU 112

ACEP Now

DECEMBER 11, 2023

Many conditions outside of acute coronary syndrome (ACS) mimic ST-elevation myocardial infarction (STEMI), but only a handful of cases have reported ST-elevations (STE) in the setting of pancreatic inflammation where underlying ACS was excluded. Emergency Medicine Reports website.Published June 1, 2016. Click to enlarge.)

STEMI 52

STEMI Coronary ACS Critical Care 52

Dr. Smith's ECG Blog

JANUARY 9, 2024

She presented to the emergency department after a couple of days of chest discomfort. Ischemia from ACS causing the chest discomfort, with VT another consequence (or coincidence)? She had a single chamber ICD/Pacemaker implanted several years prior due to ventricular tachycardia. The ECG below was recorded.

Coronary 99

Coronary ACS ED OR 99

ACEP Now

OCTOBER 11, 2024

Optimally, bystander CPR, including the administration of rescue breaths, should be initiated prior to arrival of emergency medical services. 3 Once the patient arrives in your emergency department, a rapid review of the patient’s status and results of resuscitative efforts should be performed. 2023 Jun 14;49(1):74.

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ALS Emergency Department Emergency Medical Services ED 52

ACEP Now

MAY 9, 2024

It has been well over a year since the controversial publication of the Agency for Healthcare Research and Quality (AHRQ) report on diagnostic errors in the emergency department (ED). Diagnostic errors in the emergency department: a systematic review [internet]. Ann Emerg Med. 2023 Mar-Apr;120(2):114-120.

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Emergency Department ICU ALS ACS 52

Dr. Smith's ECG Blog

APRIL 17, 2023

He had no symptoms of ACS. The remainder of his Emergency Department stay was uneventful. Here is the clinical informaton on ECG 2: A man in his 50s presented to the Emergency Department with acute chest pain that started within the past few hours. QOH: "OMI High confidence". Physician interpretation: "No STEMI."

OR 52

OR STEMI ACS Emergency Department 52

EMDocs

SEPTEMBER 25, 2023

References: Heffner AC et al. Incidence and factors associated with cardiac arrest complicating emergency airway management. actors Associated with the Occurrence of Cardiac Arrest after Emergency Tracheal Intubation in the Emergency Department. Int J Emerg Med. J Emerg Med. 2017 Dec;10(1):1.

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ED Emergency Department ALS Paramedic 66

Dr. Smith's ECG Blog

MARCH 20, 2023

I finished my residency of Emergency Medicine and I’m working at a great Emergency Department here in Brazil. Remember: these findings above are included as STEMI equivalent findings in the 2022 ACC Expert Consensus Decision Pathway on ACS Patients in the ED. Teaching is rewarding! Go teach some OMI findings. =

STEMI 52

STEMI ACS CAD ED 52

ACEP Now

NOVEMBER 14, 2023

One of the most hair-raising presentations to the emergency department (ED) can be massive hemoptysis with respiratory failure. He is the founder and host of Emergency Medicine Cases podcast and website. References Deshwal H, Sinha A, Mehta AC. The emergency department evaluation and management of massive hemoptysis.

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

Dr. Smith's ECG Blog

JANUARY 23, 2023

Submitted and written by Megan Lieb, DO with edits by Bracey, Smith, Meyers, and Grauer A 50-ish year old man with ICD presented to the emergency department with substernal chest pain for 3 hours prior to arrival. My Comment by K EN G RAUER, MD ( 1/23 /2023 ): = The importance of today's case by Drs.

ACS 52

ACS Coronary Defibrillator STEMI 52

FOAMfrat

OCTOBER 20, 2023

2023) The Walls Manual of Emergency Airway Management. Heffner AC, Swords DS, Neale MN, Jones AE. Incidence and factors associated with cardiac arrest complicating emergency airway management. Peri-intubation cardiac arrest in the Emergency Department: A National Emergency Airway Registry (NEAR) study.

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E-9-1-1 ALS ACS OR 52

Don't Forget the Bubbles

SEPTEMBER 18, 2023

This blog post aims to help familiarise you with some of the most common reasons for prescribing antibiotics in the paediatric emergency department. Antibiotic Use for Common Infections in Pediatric Emergency Departments: A Narrative Review. Antibiotics 2023, 12, 1092. cited 2023 Jan 3]. cited 2023 Jan 3].

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Emergency Department E-9-1-1 ALS OR 143

ALiEM

OCTOBER 30, 2024

Bupe Allergy Buprenorphine induction has been the mainstay of emergency department treatment of opioid use disorder for more than a decade [11, 12]. 2023 Jan 1;53(1):140-2. 2022; 06/26/2023. 2023 Jun 1;36:89-91. This month in JAAD Case Reports: August 2023: Xylazine and skin necrosis. 2023 Aug 1;89(2):231.

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E-9-1-1 Naloxone Emergency Department ALS 161

EMDocs

FEBRUARY 12, 2024

It has been found that using pulse oximetry to obtain the SpO 2 /FiO 2 ratio could help facilitate earlier ARDS recognition as pulse oximetry is more readily available and less time consuming to obtain compared with ABG, and this has been incorporated into the new proposed 2023 definition of ARDS (12). Int J Emerg Med. Eur J Emerg Med.

Emergency Department 94

Emergency Department E-9-1-1 ED ICU 94

REBEL EM

SEPTEMBER 11, 2023

1 It is a quickly deployable and easily interpreted study that can be done in real time to guide decisions in the Emergency Department. Point of care biliary ultrasound in the emergency department (BUSED) predicts final surgical management decisions. and specificity of 88.0% Trauma Surg Acute Care Open.

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ED ACS Emergency Department OR 68

EMDocs

JANUARY 20, 2024

Takotsubo syndrome is often exceedingly difficult to distinguish from acute myocardial infarction in the emergency department, as there is significant overlap in many clinical and diagnostic features. She reports worsening dyspnea on exertion for the past 2 days and a recent diarrheal illness that resolved without treatment 4 days ago.

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E-9-1-1 EMS Coronary ACS 75

Dr. Smith's ECG Blog

AUGUST 10, 2023

Case submitted and written by Dr. Mazen El-Baba and Dr. Emily Austin, with edits from Jesse McLaren A 50 year-old patient presented to the Emergency Department with sudden onset chest pain that began 14-hours ago. The pain improved (6/10) but is persisting, which prompted him to visit the Emergency Department. Shroff, G.

STEMI 86

STEMI ACS Emergency Department ED 86

Don't Forget the Bubbles

MAY 3, 2023

Published 2023 Feb 17. The Pediatric Bougie for the First Tracheal Intubation Attempt in Critically Ill Children [published online ahead of print, 2023 Feb 23]. Ann Emerg Med. 2023;S0196-0644(23)00030-6. Garabon JJW, Gunz AC, Ali A, Lim R. Prehosp Emerg Care. Crit Care Explor. 2023;5(2):e0857.

CPR 52

CPR Emergency Department ALS ICU 52

EMDocs

OCTOBER 7, 2023

Accessed February 3, 2023. J Emerg Med. Goodman AD, Got CJ, Weiss AC. Clinical spectrum of rhabdomyolysis presented to pediatric emergency department. Int J Emerg Med. Accessed 21 February 2023. Accessed 15 August 2023. He has no medical problems. He is agitated and reporting significant pain.

EMS 74

EMS E-9-1-1 Emergency Department ALS 74

EMDocs

NOVEMBER 4, 2024

54 It is vital to consider dangerous epigastric pain mimickers like acute coronary syndrome (ACS), hepatobiliary disease, or pancreatitis. The Treatment of Acute Pain in the Emergency Department: A White Paper Position Statement Prepared for the American Academy of Emergency Medicine. J Emerg Med. Acad Emerg Med.

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ED E-9-1-1 Emergency Department ALS 99

EMDocs

NOVEMBER 25, 2024

Vision loss carries a high degree of morbidity and is associated with higher all-cause mortality, 4 and it is our role as emergency providers to recognize potentially reversible causes of such adverse outcomes. Updated 2023 Aug 25]. 7 Approximately 14.6 million infected people suffer from skin disease and 1.15 Onchocerciasis.

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E-9-1-1 ALS Emergency Department OR 54

Dr. Smith's ECG Blog

DECEMBER 31, 2024

She presented to the Emergency Department at around 3.5 But thankfully, when the clinical context is clearly and highly concerning for ongoing ischemia from ACS, this distinction doesn't matter much. The chest pain was described as severe pressure radiating to both shoulders. Vital signs were within normal limits.

Coronary 114

Coronary ACS STEMI CAD 114