Dr. Smith's ECG Blog

AUGUST 9, 2024

Written by Colin Jenkins and Nhu-Nguyen Le with edits by Willy Frick and by Smith A 46-year-old male presented to the emergency department with 2 days of heavy substernal chest pain and nausea. Usefulness of automated serial 12-lead ECG monitoring during the initial emergency department evaluation of patients with chest pain.

STEMI 86

STEMI Coronary Heart Attack ACS 86

Don't Forget the Bubbles

JUNE 30, 2023

Interim results presented earlier this year show that REBOA performed within the Emergency Department increased mortality. REBOA increased deaths due to bleeding at three hours and 90 days and substantially delayed time to definitive haemorrhage control. c) Or, do both? Trauma Surg Acute Care Open.

E-9-1-1 139

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

Dr. Smith's ECG Blog

JANUARY 9, 2024

She presented to the emergency department after a couple of days of chest discomfort. However , this patient is having chest discomfort, and by definition then she should be considered not to be stable. Ischemia from ACS causing the chest discomfort, with VT another consequence (or coincidence)? What is your assessment?

Coronary 99

Coronary ACS ED OR 99

Don't Forget the Bubbles

JULY 22, 2024

This is a broad definition of “pre-school” wheeze , and whilst this addresses a large population, the aforementioned concerns of including children under two prevail. A Randomized Trial of Single-Dose Oral Dexamethasone Versus Multidose Prednisolone for Acute Exacerbations of Asthma in Children Who Attend the Emergency Department.

E-9-1-1 105

E-9-1-1 ALS ACS ED 105

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). The diagnostic error was therefore classified as relating to the delays associated with testing and its effect on subsequent definitive management.

Emergency Department 52

Emergency Department ICU ALS ACS 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. A more practical definition of massive or life-threatening hemoptysis is that which causes signs of worsening respiratory distress, hemodynamic instability, abnormal gas exchange, or airway obstruction.

E-9-1-1 52

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

EMDocs

SEPTEMBER 25, 2023

Also known as Facilitated intubation (FI), the use of intubating with only a sedative was an accepted alternative intubation technique prior to those definitive studies in the late 1990s but quickly was abandoned for RSI in all emergent endotracheal intubations (ETI) (8,9). References: Heffner AC et al. Int J Emerg Med.

ED 66

ED Emergency Department ALS Paramedic 66

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

Dr. Smith's ECG Blog

AUGUST 26, 2019

She was brought to the Emergency Department and this ECG was recorded while she was still feeling nauseous but denied chest pain, shortness of breath, or other symptoms: What do you think? There is definite STE inferior and lateral but it just doesn't look like true positive STE to me. No baseline was available for comparison.

STEMI 52

STEMI Coronary OR ED 52

FOAMfrat

OCTOBER 20, 2023

Likely due to different definitions for hypotension and adverse/major critical events, but the numbers remain higher than we would ever like — Kinda scary when you think about it. Heffner AC, Swords DS, Neale MN, Jones AE. Incidence and factors associated with cardiac arrest complicating emergency airway management. 2013.07.022.

E-9-1-1 52

E-9-1-1 ALS ACS OR 52

Dr. Smith's ECG Blog

OCTOBER 3, 2018

The Smith-Modified Sgarbossa Criteria Accurately Diagnose Acute Coronary Occlusion in Emergency Department Patients With Ventricular Paced Rhythm. Acute myocardial infarction (AMI) was defined by the Third Universal Definition of AMI. Here is our abstract from SAEM 2018. Dodd1 , Deborah L. Zvosec2 , Michael A.

Coronary 52

Coronary STEMI Paramedic ALS 52

Dr. Smith's ECG Blog

FEBRUARY 5, 2019

The clinicians later stated they had had no suspicion of ACS, but that the faculty wanted a troponin anyway. Design Prospective study of three independent consecutive patient populations presenting to emergency departments. Setting Secondary and tertiary care hospitals in the United Kingdom and United States.

STEMI 52

STEMI Emergency Department ED OR 52

Dr. Smith's ECG Blog

NOVEMBER 3, 2017

consistent with LAD occlusion) This was not recognized, repeat ECG at 69 minutes showed new Q-waves in V2-V4 that were not appreciated, and patient waited for a prolonged period in the emergency department before STEMI was diagnosed. above which one should definitely be worried and get serial ECGs. 100% LAD occlusion.

STEMI 52

STEMI Coronary OR ALS 52

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.

ED 68

ED ACS Emergency Department OR 68

AAEM RSA

DECEMBER 3, 2020

6,13,17 Challenges in Diagnosis: The diagnosis of Fournier’s gangrene is clinical: There are no laboratory or imaging studies that can be used to definitively rule out disease. 20,21 Imaging may be helpful in diagnosis or surgical planning but cannot rule out NSTI and may delay definitive surgical management. West J Emerg Med.

Emergency Department 52

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

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

EMDocs

JANUARY 6, 2024

10 Although this is not the same pathophysiology seen in ACS from an acute plaque rupture leading to coronary artery occlusion, patients can have relatively abrupt coronary ischemia causing ACS due to acute, concentric vessel narrowing. A 63-year-old man presents to the emergency department for dyspnea on exertion.

EMS 64

EMS E-9-1-1 ACS Coronary 64

Don't Forget the Bubbles

MAY 3, 2023

This single-centre academic urban institution in the United States (US) undertook a 10-year retrospective observational study of paediatric intubation and bougie use in their emergency department (ED). Garabon JJW, Gunz AC, Ali A, Lim R. Prehosp Emerg Care. 468 paediatric patients were intubated in this timeframe.

CPR 52

CPR Emergency Department ALS ICU 52

EMDocs

OCTOBER 7, 2023

6 Prolonged down time from falls, usually in the elderly Incidence is difficult to ascertain due to broad definition and that events that cause crush injuries are rather rare. J Emerg Med. Goodman AD, Got CJ, Weiss AC. A systematic review on the definition of rhabdomyolysis. Int J Emerg Med. 2014;46(2):313-319.

EMS 74

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

Dr. Smith's ECG Blog

APRIL 8, 2015

Approach to Syncope Syncope definition: Brief loss of consciousness with loss of postural tone and complete spontaneous recovery without medical intervention. This San Fran definition, however, is too non-specific , so I list more specific ECG abnormalities below: b. 2) Boston syncope rule: J Emerg Med. 2007 Oct; 33(3): 233–239.

Emergency Department 52

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

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. 5 Epidemiology Onchocerciasis is endemic in 31 African countries but is also problematic in Brazil, Venezuela, and Yemen.

E-9-1-1 54

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. Final Diagnosis: "STEMI" (of course, as you can see in the ECGs above, this is not true, by definition this was NSTEMI.

Coronary 114

Coronary ACS STEMI CAD 114

Dr. Smith's ECG Blog

NOVEMBER 10, 2024

The ECG was transmitted to the Emergency Medicine physician who recognized inferior and posterior OMI findings, and confirmed that the patient has potential ACS symptoms. EMS gave aspirin and nitroglycerin, and the patient noted significant improvement on arrival to the Emergency Department.

STEMI 85

STEMI OR ED EMS 85