Dr. Smith's ECG Blog

SEPTEMBER 23, 2024

Here is lead I from ECGs 1 and 2 shown side-by-side to highlight the change in axis from borderline right to completely normal. Consider the following: We become attuned to looking for acute coronary occlusion in patients who present with acute symptoms to the ED ( E mergency D epartment ).

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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.

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REBEL EM

FEBRUARY 29, 2024

1, 2 Its occurrence often portends worse outcomes in intubated patients, whose projected hospital course was already tenuous. 1, 4, 6 The overall incidence of VAP is somewhere around 5%-40% of all intubated patients, depending on the study and country from which it is reported. Mimoz (2024). 4, 8 Paper: Dahyot-Fizelier, C.,

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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. 2024 Mar 22 [cited 2024 Mar 25];0(0) Methods – What is an IPD meta-analysis? Future of Pre-School Wheeze Whilst Lee et al. used IgE testing.

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REBEL EM

NOVEMBER 6, 2024

Treasure Island (FL): StatPearls Publishing; 2024 Jan–. 1998 Jan-Feb;6(1):15-23. Treasure Island (FL): StatPearls Publishing; 2024 Jan–. Treasure Island (FL): StatPearls Publishing; 2024 Jan–. PMID: 32644703 Robinson PM, Griffiths E, Watts AC. 2017 Jul;9(3):195-204. 1999 Jan;13(1):58-9.

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ACEP Now

OCTOBER 11, 2024

1 Pediatric rapid sequence intubation (RSI) in the ED is associated with a higher frequency of failed first attempts and adverse effects than in adult patients. Paralytic agents include rocuronium at 1 mg/kg IV and succinylcholine at 1-2 mg/kg IV. References Long E, Sabato S, Babl FE. mg/kg IV, ketamine at 1.5–2

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This Podcast Will Kill You

OCTOBER 1, 2024

Medical journal of Australia , 190 (9). Cabezas-Cruz, Alejandro, et al. Delayed anaphylaxis, angioedema, or urticaria after consumption of red meat in patients with IgE antibodies specific for galactose-α-1, 3-galactose. Cabezas-Cruz, Alejandro, et al. Ronmark, E. Ronmark, E. Cabezas-Cruz, Alejandro, et al.

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Dr. Smith's ECG Blog

JUNE 17, 2024

Pain improved to 1/10 after EMS administers 324 mg aspirin and the following EKG is obtained at triage. C Examination notable for diaphoresis, 1+ bilateral lower extremity edema, regular heart rate and rhythm, and no signs of respiratory distress with normal breath sounds. In fact, Kosuge et al. Accessed May 28, 2024.

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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.

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Dr. Smith's ECG Blog

AUGUST 14, 2024

R waves 6 through 9 have no preceding P waves and are suspiciously regularly spaced. Depolarization wavefronts exit the sinus node through one or several sinoatrial conduction pathways (SACP) as seen in the histology section below taken from Li et al. Impulses E, F, G, H, and I were blocked. This is consistent with sinus rhythm.

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ACEP Now

FEBRUARY 13, 2024

A radiograph is shown (see figure 1). LEARN MORE The most common nerve blocks in this study are shown in Table 1. 1–4 Emergency physicians commonly prescribe opioid pain medications, and there is significant variability among prescribing patterns. In the January issue of Annals of Emergency Medicine , Merz-Herrara, et al.,

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Dr. Smith's ECG Blog

SEPTEMBER 18, 2024

To me, it was clearly atrial flutter with 1:1 conduction. Continue Eliquis 5mg BID, should be continued for 3 months == MY Comment , by K EN G RAUER, MD ( 9/18 /2024 ): == I found the following aspects of today's case of special interest. Why did Dr. Smith immediately say the rhythm was AFlutter with 1:1 AV conduction?

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ACEP Now

SEPTEMBER 3, 2024

1 Immediately after the purchase, the real estate holdings of the hospitals were spun off into a separate company owned by Paladin and other PE investors. 7-9 The PE model then aims to sell acquired businesses for a profit within three to six years. Accessed August 25, 2024. Appelbaum E, Batt R. Accessed August, 2024.

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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., After Darracq et al., A recent literature review by Caré et al. Zamora et al., From Mullens et al., His abdominal X-ray looked a lot like this.

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

FOAMfrat

MAY 19, 2024

While transporting to the emergency department, the patient’s mother informed me that PDCD affects less than 1 in 50,000 individuals and is more common in males than females. The patient will thank you for it; we are only human. References 1. Ostergaard E, Moller LB, Kalkanoglu-Sivri HS, et al. 2009 Jun 11.

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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.

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ACEP Now

OCTOBER 9, 2024

1 The diminished left ventricular function in HOCM is often associated with the thickening of the interventricular septum, which is also associated with increased left ventricular wall thickness equal to 15 mm or more. Furthermore, this genetic cardiac disease is autosomal dominant, presenting 1 in 500 in our general population.

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REBEL EM

MAY 27, 2024

No significant differences in heart rate 1 minute after cardioversion were observed between the three groups. References: Appelboam A, Reuben A, Mann C, Gagg J, Ewings P, Barton A, et al. Qiu, S., & Zhang, Q. Combined modified Valsalva maneuver with adenosine supraventricular tachycardia: A comparative study.

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OR E-9-1-1 ED ALS 137

Don't Forget the Bubbles

MAY 6, 2024

Article 1: Positive urine cultures without pyuria Wang ME, Jones VG, Kane M, et al. Clinical Course of Children 1 to 24 Months Old With Positive Urine Cultures Without Pyuria. 2024;24(1):111-118. 2024 Feb 28:fetalneonatal-2023-326501. Giannoni, E., 2024 Jan 27;403(10424):355-64. Acad Pediatr.

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Don't Forget the Bubbles

JUNE 17, 2024

Here are ten things to think about: 1. Churruca K, Pavithra A, McMullan R, Urwin R, Tippett S, Cunningham N, Loh E, Westbrook J. 2014 Jun 26;23(12):653-9. Frich JC, Brewster AL, Cherlin EJ, Bradley EH. 2020 Jan 1;35(1):70-6. InHealthcare 2024 Jan 22 (Vol. 2023 Oct 31;21(1):403. 2020 Aug 20.

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ACEP Now

JULY 7, 2024

9 By speaking out, I hope to once again find my calling in medicine. References Chieze M, Hurst S, Kaiser S, et al. Accessed May 19, 2024. Accessed May 19, 2024. 2024;15(1):3-16. Muir-Cochrane E, Oster C. Gold KJ, Andrew LB, Goldman EB, et al. “I 2020;55(3 Suppl 1):7-16. 2024;46(1):1,21.

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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. Accessed October 17, 2024. 2014;4(1):77-87.

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ALiEM

OCTOBER 30, 2024

Due in large part to the proliferation of anonymous chemical factories able to produce industrial volumes of inexpensive synthetic opioids without opium or other controlled precursors, fentanyl spilled into the United States, Canada, and Europe, heroin soon fell to market forces [1, 2]. 2024 study [16]. mg IVP Tizanidine 4 mg PO 0.15

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EMDocs

OCTOBER 5, 2024

Answer : ESBL-producing organisms Background 1-3 Extended spectrum beta-lactamases (ESBL) are enzymes produced by certain bacteria that can break down a broad range of beta-lactam antibiotics. 3 Epidemiology 4-8 ESBL-producing Enterobacteriaceae (ESBL-E) have been reported worldwide. ceftriaxone, cefepime).

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EMDocs

NOVEMBER 2, 2024

Answer : Neurosyphilis Introduction Neurosyphilis is a clinical manifestation of syphilis, a rapidly disseminating sexually transmitted infection caused by the spirochete Treponema pallidum, and humans are the only known host [1] Neuroinvasion by the treponeme may occur in the days following primary infection and is often asymptomatic.

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EMS E-9-1-1 Plasma ALS 91

EMDocs

NOVEMBER 16, 2024

1-3 Despite its commonality it retains a relatively high rate of complications overall and patients frequently present to the ED for evaluation. 9=11 70% monomicrobial, 25% poly-microbial, 5% culture-negative. 9=11 70% monomicrobial, 25% poly-microbial, 5% culture-negative. 2020 Sep 30;5(9):558-567. 10% of patients.

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EMS E-9-1-1 Operating Room Emergency Department 75

This Podcast Will Kill You

MAY 21, 2024

” Neurol Asia 9 (2004): 59-63. and Al Masud, H.A., and De Wit, E., Chua, Kaw Bing, et al. Daszak, Peter, et al. Bertherat, E., Epidemiology and Infection 147, e95, 1–6. link] 10.1017/S0950268819000086 Hauser, Naomi, et al. Journal of clinical microbiology , 56 (6), pp.10-1128. Devnath, P.,

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ACEP Now

APRIL 5, 2024

In a comprehensive review of the history of this term, Bhatia, et al. 18-21 In a recent systematic review, Strömmer, et al. Bhatia BS, Heisler M, et al. Accessed March 26, 2024. Accessed March 26, 2024. Accessed March 26, 2024. Accessed March 26, 2024. DeBard ML, Adler J, et al. May 14, 1989.

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EMDocs

NOVEMBER 4, 2024

1 The ED is a fast-paced environment where patient stability and life-and-limb-threatening conditions are prioritized. The pain began abruptly 1 hour ago, described as a stabbing sensation, and has occurred daily at the same time for the past week, each episode lasting about 45 minutes. Pain can be improved or exacerbated with meals.

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REBEL EM

NOVEMBER 11, 2024

Article: Chanderraj R, Admon AJ, He Y, et al. What They Did: Investigators performed a retrospective cohort study in the Emergency Department at the University of Michigan between July 1, 2014 through December 31, 2018. Comorbidity Index : Higher in the cefepime group (median 2 vs. 1). In 2021, Buckley et. JAMA Intern Med.

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