Dr. Smith's ECG Blog

OCTOBER 15, 2024

He arrived to the ED by helicopter at 1507, about three hours after the start of his chest pain while chopping wood around noon. He arrived to the ED by ambulance at 1529, only a half hour after the start of his chest pain around 1500 while eating. Patient 2 , EKG 1: What do you think? The patient had none of these conditions.

OR 111

OR STEMI Coronary ED 111

ALiEM

FEBRUARY 28, 2024

Accessed February 20, 2024. February 2024. Accessed February 20, 2024. Updated February 2024. Accessed February 20, 2024. Accessed February 20, 2024. Accessed February 20, 2024. References Iverson C, ed. Zipper Removal for Skin Entrapment. CorePendium. Podcast Title. Episode Title. CorePendium.

OR 130

OR ED 130

Dr. Smith's ECG Blog

NOVEMBER 19, 2024

He arrived at the ED just shy of two hours after onset, pain free. Here is the initial ED ECG: Here that first ECG is cleaned up by PM Cardio app: What do you think? The pain was relieved by one prehospital NTG spray. No prior similar symptoms or known CAD. PMHX significant for hypertension and BPH. ng/L) -- slightly elevated.

OR 64

OR STEMI Coronary CAD 64

The Skeptics' Guide to EM

NOVEMBER 2, 2024

Date: October 29, 2024 Reference: Galili et al. AEM Oct 2024. Guest Skeptic: Dr. Neil Dasgupta is an emergency medicine physician and ED intensivist from Long Island, NY. Case: You are hitting the zone in your shift, a veritable disposition machine meeting the constant flow of patients through the emergency department (ED).

Emergency Department 244

Emergency Department ED ALS EMS 244

Don't Forget the Bubbles

OCTOBER 2, 2024

Children often spend many hours in the emergency department (ED) before being sent home or admitted. The average waiting time for the first assessment was only a few minutes shorter when going through the ED. Still, treatment initiation was significantly faster (up to one hour) than admission through the ED. 2024 Sep 30.

ALS 52

ALS Emergency Department ED ACS 52

Broome Docs

MAY 31, 2024

Welcome to the June edition of the Journal Club for 2024. Do we need to intubate French drunkards in ED? 2024 Apr 1:e240167. Welcome to the June edition of the Journal Club for 2024. Articles linked below and podcast available on your favourite player or YouTube over at the First10EM channel. JAMA Pediatr.

E-9-1-1 97

E-9-1-1 ED Critical Care ICU 97

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. Diagnostic Accuracy of D-Dimer for Acute Aortic Syndromes: Systematic Review and Meta-Analysis. Her pain seems to have settled.

Emergency Department 201

Emergency Department ACS Coronary ALS 201

The Skeptics' Guide to EM

JULY 6, 2024

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. Background: We have discussed agitation in the ED on the SGEM several times. Reference: Tjan et al. Reference: Tjan et al.

ED 203

ED ALS Emergency Department OR 203

Don't Forget the Bubbles

MAY 8, 2024

2024 Apr 27. 2024 Apr 16:archdischild-2024-326876. Arch Dis Child Fetal Neonatal Ed. 2024 Apr 11 Why all newborn hip screening programs have same results-a mini review. Arch Dis Child Fetal Neonatal Ed. 2024 Apr 11 Why all newborn hip screening programs have same results-a mini review. 2024 Apr 9.

E-9-1-1 69

E-9-1-1 ALS Emergency Department Epinephrine 69

The Skeptics' Guide to EM

MARCH 2, 2024

AEM February 2024. Date: February 28, 2024 Guest Skeptic: Dr. Neil Dasgupta is an emergency medicine physician and ED intensivist from Long Island, NY. AEM February 2024. Date: February 28, 2024 Guest Skeptic: Dr. Neil Dasgupta is an emergency medicine physician and ED intensivist from Long Island, NY.

Operating Room 301

Operating Room Emergency Department ALS ED 301

Broome Docs

APRIL 30, 2024

Join Justin and I for a sold 80 minutes of nerdy evidence-based ED care. 2024 Mar 18:e240762. 2024 Apr 1;52(4):521-530. 2024 Apr 4;390(13):1186-1195. Join Justin and I for a sold 80 minutes of nerdy evidence-based ED care. Another month and another batch of fascinating papers from the Morgenstern vaults.

Operating Room 70

Operating Room Critical Care ED OR 70

Dr. Smith's ECG Blog

NOVEMBER 14, 2024

I found out that the interventionalist had just finished a case and came to the ED to see about the de-activated case. He saw the ECG and ordered an ED ECG." As per Dr. Smith — I also found it difficult to understand why the admitting ED physicians cancelled the cath lab activation. Kudos to the medics." "I

ED 120

ED Coronary Paramedic OR 120

EMDocs

AUGUST 13, 2024

HTN was the primary diagnosis in over 1 million ED visits in 2023, and rates of HTN emergencies have increased over the past 20 years. From 2006-2013, HTN emergencies occurred in approximately 2 of every 1000 adult ED visits. In the ED setting, they recommend avoiding intensifying HTN medications. 2024 Aug;81(8):e94-e106.

ED 83

ED OR 83

The Skeptics' Guide to EM

APRIL 13, 2024

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. When she arrives in your ED, her family tells you she was last seen normal about 12 hours ago. Reference: Albers GW et al.

ALS 287

ALS Emergency Department OR EMS 287

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. CMAJ September 2024 Population: Patients admitted to the General Internal Medicine (GIM) unit of an academic medical center

ICU 142

ICU Emergency Department ALS EMS 142

Don't Forget the Bubbles

AUGUST 4, 2024

2024 Jul 9:e2023064794. 2024 Jul 8. 2024 Jul 21. 2024 Jul 22;29(4):255-269. 2024 Jul 29. 2024 Jul 20;404(10449):277-293. 2024 Jul 11. 2024 Jul 11. 2024 Jul 5. 2024 Jul 8:archdischild-2024-327040. 2024 Jul 8:e242044. More studies on this topic will surely follow.

E-9-1-1 52

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

Dr. Smith's ECG Blog

SEPTEMBER 18, 2024

male presents to the ED at 6:45 AM with left sided chest dull pressure that woke him up from sleep at 3am. He arrived to the ED at around 6:45am, and stated the pain has persisted. Here is his ED ECG at triage: Obvious high lateral OMI that does not quite meet STEMI criteria. The pain radiated to both shoulders.

Coronary 119

Coronary ACS OR EMR 119

ACEP Now

JANUARY 13, 2024

The Centers for Medicare and Medicaid Services (CMS) released the 2024 Medicare Physician Fee Schedule Final rule on November 2. If we apply the revised 2024 final conversion factor of $32.7442 the ED E/M codes payments should look like Figure 1. Click to enlarge.

Critical Care 52

Critical Care ED OR 52

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.

STEMI 119

STEMI ED Coronary EMS 119

Don't Forget the Bubbles

OCTOBER 10, 2024

This time the team from Bristol Royal Children’s Hospital ED tell us what is new in the world of paediatric literature… Led by Dr John Coveney a Paediatric Emergency Medicine Trainee in Bristol who has revived The Journal Club at Bristol Royal Children’s Hospital ED on a monthly basis. 2024 Jul 29;8(1):e002737.

ED 75

ED Emergency Department OR ALS 75

REBEL EM

MAY 27, 2024

PMID: 38281376. Clinical Question: Does simultaneously performing the modified valsalva maneuver and administering intravenous adenosine, compared to either treatment alone, have greater success in achieving normal sinus rhythm in patients presenting to the ED with PSVT? Qiu, S., & Zhang, Q.

OR 137

OR E-9-1-1 ED ALS 137

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? 2024 Feb 6:S0196-0644(24)00004-0. There is something for everyone in here! 2023 Mar 30;110(4):432-438. 2023 Nov 11.

Emergency Department 103

Emergency Department ALS OR ED 103

Broome Docs

MARCH 28, 2024

2024 Jan 22;41(2):96-102. 2024 Jan 2;53(1):afad255. 2024 Jan 29:jme-2023-109651. High dose nitro for SCAPE Siddiqua N, Mathew R, Sahu AK, Jamshed N, Bhaskararayuni J, Aggarwal P, Kumar A, Khan MA. High-dose versus low-dose intravenous nitroglycerine for sympathetic crashing acute pulmonary edema: a randomised controlled trial.

E-9-1-1 107

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

Pediatric EM Morsels

AUGUST 9, 2024

Foles, 2024 ] Early = symptoms appear within the first 2 years of life (usually within first 3 months) Late = symptoms appear after 2 years of age. Foles, 2024 ] In the US, from 2013-2018, cases increased from 362 to 1,306. Neonates presenting to the Emergency Department often cause a lot of uncertainty. Is this scalp swelling normal?

E-9-1-1 152

E-9-1-1 Plasma Emergency Department OR 152

Don't Forget the Bubbles

FEBRUARY 5, 2024

2024 Jan 8. 2024 Jan 1;43(1):e11-e13. 2024 Jan 12:archdischild-2023-326225. 2024 Jan 23:archdischild-2023-325984. 2024 Jan 9. 2024 Jan 8:e2023063654. 2024 Jan 8:e2023063801. 2024 Jan 6. 2024 Jan 2. 2024 Jan 1;153(1):e2022060119. 2024 Jan 1;153(1):e2023063039. Eur J Pediatr.

E-9-1-1 52

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

The Skeptics' Guide to EM

JUNE 1, 2024

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. Reference: Tavender E, et al. Cochrane Database Syst Rev.

Emergency Medical Services 210

Emergency Medical Services Emergency Department EMS ALS 210

ACEP Now

APRIL 5, 2024

A 68-year-old man presents to the emergency department (ED) with altered mental status and fever. The study found a mean increase in time to intubation of 13 seconds in the ED setting. Vital signs on arrival are: Temperature: 38.8 He has an absent gag reflex. There was no analysis of operator experience or expertise.

OR 73

OR ALS Emergency Department Critical Care 73

Don't Forget the Bubbles

JANUARY 1, 2024

Arch Dis Child Fetal Neonatal Ed. 2024 Jan 1;43(1):74-83. This comprehensive list is developed from 34 journals, including major and subspecialty paediatric journals. We suggest this list can help you discover relevant or interesting articles for your local journal club or allow you to keep a finger on the pulse of paediatric research.

ALS 98

ALS OR ED 98

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. Naloxone and Patient Outcomes in Out-of-Hospital Cardiac Arrests in California. JAMA Network Open.

Naloxone 242

Naloxone NARCAN Overdose CPR 242

ACEP Now

JANUARY 30, 2024

Live and in person for the first time in three years, the PEM Assembly is part of this year’s ACEP Accelerate, where you can fuel your future with four different, professional, enhancing tracks, including the ED Director’s Academy and the Reimbursement and Coding Conferences. Look for “Qual-ED” in your preferred podcast platform.

ED 52

ED EMS OR 52

ALiEM

JUNE 10, 2024

A 10-year-old boy presents to the emergency department (ED) after a high-speed motor vehicle collision. The study enrolled 22,430 children, aged 0–17 years, presenting with blunt trauma across 18 PECARN-affiliated ED in the US. Case Scenario: What would you do? He complains of neck pain and is reluctant to move his head.

Emergency Department 317

Emergency Department ED OR 317

The Skeptics' Guide to EM

NOVEMBER 9, 2024

Date: October 28, 2024 Reference: Woelfle T et al. J Clin Epi Sept 2024. In addition to finding ways to use technology in emergency department (ED) care, she is interested in how health systems work and how patients move through the healthcare system. Benchmarking Human–AI collaboration for common evidence appraisal tools.

Emergency Department 140

Emergency Department ED ALS OR 140

Pediatric EM Morsels

JANUARY 19, 2024

Now, let’s discuss another complication of “The Great Mimicker” which may throw us for a loop in the ED – Pseudoparalysis of Parrot : Pseudoparalysis of Parrot – Basics First described by Jules Marie Parrot in 1871. We have touched on the treatment for older children with syphilis with Bicillin CR vs LA.

Plasma 269

Plasma OR EMS ED 269

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

The Skeptics' Guide to EM

JULY 20, 2024

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. Case: A 70-year-old man presents to the emergency department (ED) with an exacerbation of COPD. NEJM June 2024. Reference: Gibbs et al. Reference: Gibbs et al.

ALS 227

ALS Emergency Department ED OR 227

The Skeptics' Guide to EM

SEPTEMBER 14, 2024

Date: September 12, 2024 Reference: Anderson et al. AEM August 2024. Case: It’s another day, another dollar in the emergency department (ED). You wonder if she could have an allergy challenge dose of ceftriaxone in the ED. Emergency Physicians frequently encounter ED patients with self-reported penicillin allergies.

ICU 136

ICU Emergency Department ALS ED 136

ACEP Now

SEPTEMBER 5, 2024

Creation of an accurate database of emergency physicians living and working within a state, as well as a network of each states’ EM groups and ED medical directors would help chapter leaders disseminate relevant information, strengthen advocacy efforts, and plan regional solutions summits to focus on unique challenges.

EMS 98

EMS OR Emergency Department ED 98