Dr. Smith's ECG Blog

NOVEMBER 23, 2024

Compared to TTE from 7/3/24: the anterior regional wall motion abnormality is new and is consistent with ischemia/infarction in the LAD territory == MY Comment , by K EN G RAUER, MD ( 11/20 /2024 ): == There are several insightful aspects of today's case. The November 8, 2024 post — artifact complicating OMI assessment.

OR 63

OR Critical Care ALS STEMI 63

FOAMfrat

SEPTEMBER 24, 2024

Retrieved August 8, 2024, from [link] Pease, M., It’s probably safe to assume that your patient has a traumatic brain injury, so at what point in your treatment pathway do you reach for an antiepileptic drug (AED)? Are you carrying antiepileptics on your truck or aircraft? To give an AED or not to give an AED, that is the question. (Bet

OR 106

OR ALS 106

The Skeptics' Guide to EM

OCTOBER 12, 2024

Reference: Ma K et al. June 2024 Date: Oct 1, 2024 Guest Skeptic: Dr. Andrew (Andy) Tagg is an Emergency Physician with a special interest in education and lifelong learning. Reference: Ma K et al. A national survey of children’s experiences and needs when attending Canadian pediatric emergency departments.

Emergency Department 229

Emergency Department ED ALS OR 229

The Skeptics' Guide to EM

APRIL 13, 2024

Reference: Albers GW et al. NEJM Feb 2024 Date: April 12, 2024 Guest Skeptic: Dr. Vasisht Srinivasan is an Emergency Medicine physician and neurointensivist at the University of Washington and Harborview Medical Center in Seattle, WA. Reference: Albers GW et al. TIMELESS Investigators. Tenecteplase for Stroke at 4.5

Emergency Department 287

Emergency Department ALS OR EMS 287

The Skeptics' Guide to EM

NOVEMBER 2, 2024

Date: October 29, 2024 Reference: Galili et al. AEM Oct 2024. Reference: Galili et al. AEM Oct 2024. Low dose ketamine as an adjunct to morphine: a randomized controlled trial among patients with and without current opioid use.

Emergency Department 244

Emergency Department ED ALS EMS 244

The Skeptics' Guide to EM

OCTOBER 5, 2024

Date: October 2, 2024 Reference: Paxton et al. AEM Sept 2024 Guest Skeptic: Dr. Lauren Westafer an Assistant Professor in the Department of Emergency Medicine at the UMass Chan Medical School – Baystate. Reference: Paxton et al. The patient had some slurred speech but no obvious facial droop or asymmetric limb weakness.

Emergency Medical Services 262

Emergency Medical Services ALS EMS Paramedic 262

Don't Forget the Bubbles

JANUARY 1, 2024

Musolino AM, et al. Chidini G, et al. Pawlowski TW, et al. Weiss SL, et al. Hua LL, et al. Delany C, et al. Kuehn LM, et al. Woods CR, et al. Montini G, et al. Redline S, et al. Hazkani I, et al. They enrolled 459 children aged 3 to 12.9 Eur J Pediatr. 2023 Dec 22.

ALS 98

ALS OR ED 98

Pediatric EM Morsels

NOVEMBER 15, 2024

Have you ever had that feeling of falling that rapidly wakes you from sleep? While it’s unlikely that you were having Benign Epilepsy with CentroTemporal Spikes (BECTS) seizures or a benign Rolandic seizure, that tenuous state between sleeping and waking is a time when some odd neurologic things can happen, including BECTS.

ALS 152

ALS OR EMS 152

Broome Docs

FEBRUARY 22, 2024

Welcome to the first episode for 2024 – and we have a range of papers covering the big life threatening issues to the tiniest pinky finger injuries and a lot in between. Should anybody be doing REBOA in 2024? Carson JL, Brooks MM, Hébert PC, et al; MINT Investigators. 2024 Feb 6:S0196-0644(24)00004-0. N Engl J Med.

Emergency Department 103

Emergency Department ALS OR ED 103

The Skeptics' Guide to EM

SEPTEMBER 28, 2024

Date: September 23, 2024 Reference: Essat et al. Annals of Emergency Medicine, May 2024 Guest Skeptic: Dr. Casey Parker is a Rural Generalist from Australia who is also an ultrasounder. Reference: Essat et al. Diagnostic Accuracy of D-Dimer for Acute Aortic Syndromes: Systematic Review and Meta-Analysis.

Emergency Department 201

Emergency Department ACS Coronary ALS 201

The Skeptics' Guide to EM

NOVEMBER 16, 2024

Date: October 28, 2024 Reference: Verma et al. CMAJ September 2024 Guest Skeptic: Michael Page is currently the Director of Artificial Intelligence (AI) Commercialization at Unity Health Toronto. Reference: Verma et al. Clinical evaluation of a machine learning–based early warning system for patient deterioration.

ICU 154

ICU Emergency Department ALS EMS 154

The Skeptics' Guide to EM

MARCH 2, 2024

Reference: Gibbons et al. AEM February 2024. Date: February 28, 2024 Guest Skeptic: Dr. Neil Dasgupta is an emergency medicine physician and ED intensivist from Long Island, NY. Reference: Gibbons et al. AEM February 2024. The pain is often described as tearing or ripping.

Operating Room 301

Operating Room Emergency Department ALS ED 301

Don't Forget the Bubbles

FEBRUARY 5, 2024

2024 Jan 8. 2024 Jan 1;43(1):e11-e13. Anagnostou A, et al. 2024 Jan 12:archdischild-2023-326225. Rodgers O, et al. 2024 Jan 23:archdischild-2023-325984. Schoeffl I, et al. 2024 Jan 9. Garfinkle J, et al. 2024 Jan 8:e2023063654. 2024 Jan 8:e2023063801. Peprah P, et al.

E-9-1-1 52

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

The Skeptics' Guide to EM

SEPTEMBER 21, 2024

Date: September 18, 2024 Reference: Dillon et al. August 20, 2024 Guest Skeptic: Dr. Chris Root is an emergency medicine and emergency medicine service (EMS) physician at the University of New Mexico, Albuquerque. Reference: Dillon et al. Naloxone and Patient Outcomes in Out-of-Hospital Cardiac Arrests in California.

Naloxone 242

Naloxone NARCAN Overdose CPR 242

ACEP Now

APRIL 5, 2024

References von Hellmann R, Fuhr N, et al. Koh LK, Kong CE, et al. A study in the February issue of Annals conducted a meta-analysis of 18 studies and concluded that bougie use was associated with increased first-attempt intubation success. Some important limitations of this analysis should be recognized. Ann Emerg Med.2024;83(2):132-144.

OR 73

OR ALS Emergency Department Critical Care 73

The Skeptics' Guide to EM

NOVEMBER 23, 2024

Date: November 13, 2024 Reference: Lee WH, et al. Dec 2024 Guest Skeptic: Dr. Dennis Ren is a pediatric emergency medicine physician at Children’s National Hospital in Washington, DC. Study of Pediatric Appendicitis Scores and Management Strategies: A Prospective Observational Feasibility Study. Academic Emergency Medicine.

ED 159

ED Emergency Department ALS OR 159

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

Broome Docs

MARCH 28, 2024

2024 Jan 22;41(2):96-102. Great evidence for button battery ingestions (if you are treating a dead pig) Chiew AL, Lin CS, Nguyen DT, Sinclair FAW, Chan BS, Solinas A. 2024 Jan 2;53(1):afad255. 2024 Jan 29:jme-2023-109651. Emerg Med J. doi: 10.1136/emermed-2023-213285. Ann Emerg Med. 2023 Sep 19:S0196-0644(23)00671-6.

E-9-1-1 107

E-9-1-1 ICU Emergency Department ALS 107

The Skeptics' Guide to EM

JULY 6, 2024

Reference: Tjan et al. AEM June 2024 Date: July 5, 2024 Guest Skeptic: Dr. Lauren Westafer an Assistant Professor in the Department of Emergency Medicine at the University of Massachusetts Medical School – Baystate. Reference: Tjan et al. Conflict in emergency medicine: A systematic review.

ED 203

ED ALS Emergency Department OR 203

The Skeptics' Guide to EM

JUNE 1, 2024

Reference: Tavender E, et al. 2024 Date: May 29, 2024 Guest Skeptic: Dr. Caleb Ward is a pediatric emergency medicine attending and Associate Professor of Pediatrics and Emergency Medicine at Children’s National Hospital and The George Washington School of Medicine and Health Sciences in Washington, DC.

Emergency Medical Services 210

Emergency Medical Services Emergency Department EMS ALS 210

The Skeptics' Guide to EM

JULY 20, 2024

Reference: Gibbs et al. NEJM June 2024. Date: July 17, 2024 Guest Skeptic: Dr. Aine Yore is an Emergency Physician, practicing in the Seattle, Washington area for over twenty years. Reference: Gibbs et al. NEJM June 2024. Noninvasive Ventilation for Preoxygenation during Emergency Intubation (The PREOXI trial).

ALS 227

ALS Emergency Department ED OR 227

The Skeptics' Guide to EM

APRIL 27, 2024

Reference: Tanner et al, A retrospective comparison of upper and lower extremity intraosseous access during out-of-hospital cardiac arrest resuscitation. February 2024. Reference: Tanner et al, A retrospective comparison of upper and lower extremity intraosseous access during out-of-hospital cardiac arrest resuscitation.

ICU 189

ICU Defibrillator CPR Paramedic 189

Don't Forget the Bubbles

NOVEMBER 6, 2024

Catassi G, et al. 2024 Dec;183(12):5085-5101. Marciano L, et al. 2024 Oct 1;154(4):e2024066142 A Review of Hyperventilation Activation in Diagnosis and Management of Childhood Absence Epilepsy. Rao CK, et al. 2024 Oct;39(11-12):425-432. Hale L, et al. 2024 Oct 1;178(10):963-964 2.Original

ALS 59

ALS ED OR EMS 59

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. 2023 [cited 2024 Apr 10]. 2024 [cited 2024 Apr 14]. Pediatric Critical Care Medicine.

OR 49

OR Critical Care ALS Emergency Department 49

The Skeptics' Guide to EM

AUGUST 24, 2024

Date: August 19, 2024 Reference: Partyka et al. JAMA Surg 2024 Guest Skeptic: Dr. Sean Baldwin is an Emergency Physician practising in Sydney, Australia in both a large tertiary emergency department and a small regional emergency department. Reference: Partyka et al.

Emergency Department 129

Emergency Department ALS OR ED 129

The Skeptics' Guide to EM

APRIL 20, 2024

AEM April 2024 Date: April 19, 2024 Guest Skeptic: Dr. Suchismita Datta. AEM April 2024 Date: April 19, 2024 Guest Skeptic: Dr. Suchismita Datta. A clinical decision tool called the STUMBL score was derived and validated by Battle et al in 2014 [3]. These risks are particularly higher in the elderly [2].

Emergency Department 207

Emergency Department Overdose ALS ED 207

REBEL EM

MAY 27, 2024

Given that these two treatment options operate via different physiologic mechanisms, the author of this study postulates that MVM and IV adenosine could be combined synergistically to convert PSVT with better success rates than either treatment individually and with better safety profiles. Article: Xiao, L., Qiu, S., & Zhang, Q.

OR 137

OR E-9-1-1 ED ALS 137

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. NEJM May 2024 Guest Skeptic: Dr. Vasisht Srinivasan is an Emergency Medicine physician and neurointensivist at the University of Washington and Harborview Medical Center in Seattle, WA.

Emergency Medical Services 176

Emergency Medical Services ALS Emergency Department ED 176

Pediatric EM Morsels

JUNE 21, 2024

Liu 2024] A silver-based dressing has been shown to have longer healing times as compared to antibiotic ointment when compared head-to-head. Or maybe you have the adventurous adolescent who was a little too aggressive with the lighter fluid before igniting the campfire.

ALS 169

ALS OR EMS 169

The Skeptics' Guide to EM

JULY 27, 2024

Reference: Knack et al. A similar review by Sanders et al 2015 concludes that clinica. Early Physician Gestalt Versus Usual Screening Tools for the Prediction of Sepsis in Critically Ill Emergency Patients. A randomized control trial (RCT) done in the prehospital setting enrolled 2,698 patients.

ICU 187

ICU ALS Ambulance OR 187

Pediatric EM Morsels

JULY 5, 2024

It seems like just yesterday ( or maybe ~ a month ago ) when we served up a tasty morsel on the PECARN decision rule for intra-abdominal traumatic injuries in children. Our friends at the PECARN injury group have remained busy this spring with generating more externally validated clinical decision rules. High Risk (12.8% High Risk (12.8%

ALS 161

ALS OR ED Emergency Department 161

The Skeptics' Guide to EM

SEPTEMBER 14, 2024

Date: September 12, 2024 Reference: Anderson et al. AEM August 2024. A pivotal study by Raja et al. Koo et al showed that offering amoxicillin oral challenges to ICU patients with low-risk penicillin allergies. Full dose challenge of moderate, severe and unknown beta-lactam allergies in the emergency department.

ICU 136

ICU Emergency Department ALS ED 136

The Skeptics' Guide to EM

FEBRUARY 11, 2024

Reference: McLatchie et al and DAShED investigators. Date: February 11, 2024 Guest Skeptic: Nirdosh Ashok Kumar, Emergency Medicine Specialist – Aga Khan University Hospital, Karachi, Pakistan. […] The post SGEM#430: De Do Do Do, De Dash, Dash DAShED – Diagnosing Acute Aortic Syndrome in the ED. EMJ Nov 2023. EMJ Nov 2023.

ED 303

ED Emergency Department ALS OR 303

ALiEM

JANUARY 5, 2024

What does the Electronic Residency Application Service (ERAS) preliminary data show just far for the 2024 residency application season? Aaron Kraut (University of Wisconsin PD) in this insightful, rapid-fire, practical episode through the lens of experienced residency program directors. Has the program signaling option been working?

EMS 177

EMS ALS OR 177

The Skeptics' Guide to EM

JANUARY 13, 2024

Reference: Snyder BD, Van Dyke MR, Walker RG, et al. Reference: Snyder BD, Van Dyke MR, Walker RG, et al. Date: January 11, 2024 Guest Skeptic: Dr. Chris Root is an EMS fellow in the Department of Emergency Medicine at the University of New Mexico Health Sciences Center in Albuquerque, NM. Resuscitation 2023. Resuscitation 2023.

CPR 223

CPR Defibrillator First Responder Epinephrine 223

The Skeptics' Guide to EM

NOVEMBER 9, 2024

Date: October 28, 2024 Reference: Woelfle T et al. J Clin Epi Sept 2024. Benchmarking Human–AI collaboration for common evidence appraisal tools. Guest Skeptic: Dr. Laura Walker is an Associate Professor of Emergency Medicine and the vice chair for digital emergency medicine at the Mayo Clinic.

Emergency Department 140

Emergency Department ED ALS OR 140

EMOttawa

JUNE 24, 2024

5 Usefulness: 2/5 Nasr Isfahani M, et al. 2024 Jan 25;24(1):15. Methodology: 3.5/5 BMC Emerg Med. Question and Methods: This triple blinded RCT of 158 patients with isolated closed limb fractures assessed pain scores at 1-hour following the administration of intravenous acetaminophen, acetaminophen plus ibuprofen, or morphine.

OR 52

OR ALS 52