EMDocs

MAY 28, 2024

Sickling leads to vascular occlusion, end-organ ischemia, and decreased RBC lifespan, which, in turn, leads to pain crisis, acute anemia, sequestration, infection, and acute chest syndrome (ACS). ACS is lung injury due to vaso-occlusion in the pulmonary vasculature; many with ACS will have a concomitant vaso-occlusive pain crisis.

ACS 75

ACS E-9-1-1 ALS OR 75

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? Other lung fields unremarkable. C or 100.4 mg/kg, max 0.4

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E-9-1-1 ICU ACS EMS 75

REBEL EM

NOVEMBER 30, 2023

Article: Vaeli Zadeh A, Wong A, Crawford AC, Collado E, Larned JM. Guideline-based and restricted fluid resuscitation strategy in sepsis patients with heart failure: A systematic review and meta-analysis [published online ahead of print, 2023 Aug 9]. References: Vaeli Zadeh A, Wong A, Crawford AC, Collado E, Larned JM.

E-9-1-1 122

E-9-1-1 ALS ACS ICU 122

ECG & Echo Learning

MARCH 8, 2023

All patients with NSTE-ACS ( NSTEMI or unstable angina) are treated similarly with respect to anti-ischemic and anti-thrombotic drugs. Guidelines recommend the use of validated risk models to estimate the risk of acute myocardial infarction , 30-days and 1-year mortality in patients with NSTE-ACS. Circulation.

STEMI 40

STEMI E-9-1-1 ACS Coronary 40

EMDocs

OCTOBER 8, 2024

Discharging a patient with abnormal vital signs has been linked to unanticipated death (1-4). The full differential diagnosis of sinus tachycardia in isolation is extensive ranging from benign etiologies such as anxiety to severely life threatening etiologies such as sepsis. At this point there are two large questions. #1. SPO2 Any hypoxia?

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E-9-1-1 Emergency Department ED ALS 95

FOAMfrat

APRIL 22, 2024

This kid had sticks go through his cheek from running with a lollipop, hit by a car, almost kidnapped, attacked by a dog, and almost burnt his house down by throwing a 9-volt battery in the trash. References Kimbrell J, Kreinbrook J, Poke D, Kalosza B, Geldner J, Shekhar AC, Miele A, Bouthillet T, Vega J.

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E-9-1-1 ACS Paramedic Critical Care 78

Don't Forget the Bubbles

JULY 22, 2024

study from 200 9. However, there was no difference in LOS (83 minutes for placebo vs 79 minutes for prednisolone) in participants who were discharged straight from the ED ( 32% ). Compare this with the Panickar et al. The children were younger (10-72 months, mean 25 months) were younger.

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E-9-1-1 ALS ACS ED 105

Dr. Smith's ECG Blog

SEPTEMBER 10, 2023

References: 1) See this study showing an association between morphine and mortality in Non-STE-ACS: Meine TJ, Roe M, Chen A, Patel M, Washam J, Ohman E, Peacock W, Pollack C, Gibler W, Peterson E. Despite not being considered in this category, opioid medications are sometimes given for ACS. Am Heart J.

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E-9-1-1 ACS STEMI Coronary 78

Dr. Smith's ECG Blog

MARCH 1, 2023

This pattern occurs regardless of whether the cause is ACS (decreased supply) or any other cause of decreased supply or increased demand. You must understand that this pattern does not differentiate ACS from other causes of supply/demand mismatch. ST depression will not always be present in 9/12 leads — as is seen in Figure-1.

Allergic Reaction 52

Allergic Reaction E-9-1-1 Epinephrine Coronary 52

EMDocs

JUNE 14, 2023

Patellar reflexes are 1+. 1, 2, 4, 9 Organophosphates are one of many types of insecticide and are used worldwide to manage crops. 1, 2, 4, 9 Organophosphates are one of many types of insecticide and are used worldwide to manage crops. 1, 2 Sensory > Motor neurons with predilection for long axons.

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E-9-1-1 Emergency Department Plasma ACS 70

Dr. Smith's ECG Blog

NOVEMBER 15, 2023

Angiogram No obstructive epicardial coronary artery disease Cannot exclude non-ACS causes of troponin elevation including coronary vasospasm, stress cardiomyopathy, microvascular disease, etc. IMPRESSION: 1. It is not yet available, but this is your way to get on the list. I don't know if her pain was getting better or not.

Coronary 101

Coronary E-9-1-1 STEMI ACS 101

Don't Forget the Bubbles

JULY 5, 2023

Figure 1: Clinical manifestations and long-term consequences of sickle cell disease Training and education on sickle cell disease: Training and education are crucial to improve morbidity and mortality. Investigations : Bloods show Hb of 8 g/L, White cell count 13x 10 9 /L, Platelets 570 x10 9 /L, CRP 35mg/L.

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E-9-1-1 ACS OR ICU 126

EMDocs

JUNE 7, 2023

1-5 Farmers also treat sheep for parasites using OPs and may become symptomatic after exposure, an illness called Dipper’s Flu. 8 Intermediate syndrome Occurs 1 to 5 days after acute exposure in up to 40% on individuals. 7, 9 Often have absence of excessive cholinergic stimulation. 7 May lead to respiratory failure.

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E-9-1-1 ICU Emergency Department ED 83

Pediatric EM Morsels

AUGUST 18, 2023

Myth #1: Musculoskeletal Adverse Events (MAE) This concern is likely the most common reason fluoroquinolones are rarely used in children. Which is a risk of 1 event for 62.5 Fluoroquinolone Use in Children: A Bad Rep? Hersh 2014) Another study looked at all MAEs in juvenile beagles given either low dose or high dose fluoroquinolone.

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Dr. Smith's ECG Blog

NOVEMBER 14, 2023

Learning Point: 1. For examples of such exceptions — See My Comment in the January 9, 2019 — August 22, 2020 — and June 30, 2023 posts in Dr. Smith's ECG Blog ). Figure-1: Comparison between the first 3 ECGs in today's case. How Would YOU Interpret the Serial Tracings in Figure-1? So they looked into the patient's chart.

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E-9-1-1 Coronary EMS ED 107

Don't Forget the Bubbles

JUNE 30, 2023

He has already climbed Ben Nevis in Scotland, visited the Gobi desert (possibly from the comfort of his parents 4 x 4, but who’s judging) and has his bronze D of E nailed. She calls out her findings: A – OK B – 1 puncture mark to the anterior left chest wall, covered with a three-sided dressing. RR 25-30. Actively oozing.

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

Dr. Smith's ECG Blog

FEBRUARY 28, 2020

Some providers were worried about ACS because of this ECG. My answer alleviated their concern for ACS and no further workup was done for ACS. 4 important features that indicate acute right hear strain: 1. looked at consecutive patients with PE, ACS, or neither. Tachycardia (or nearly) 2. Poor R-wave progression 4.

E-9-1-1 52

E-9-1-1 ACS ALS OR 52

FOAMfrat

OCTOBER 20, 2023

As reported within the 6th edition Manual of Emergency Airway Management, there are cardiac arrest rates between 1% and 4%, with other complications (mostly hypoxemia and hypotension) as high as 30% in patients with first-pass success [1, pg 29; 4-10]. Why is Physiologic Optimization Important? Up to 44% per other sources [12].

E-9-1-1 52

E-9-1-1 ALS ACS OR 52

Don't Forget the Bubbles

SEPTEMBER 13, 2023

When considering tumours, 37 observation studies involving 2661 children found that 3% (95% CI 1-7%) had tumours. Each article will take a deeper dive into each recommendation’s supporting evidence and practical implications. The parents of 18-month-old Susie brought her to the Emergency Department after she had a seizure at home.

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E-9-1-1 Emergency Department ALS OR 131

Dr. Smith's ECG Blog

NOVEMBER 9, 2023

Over the last 1 week, her exertional chest pain became worse both in intensity and triggering threshold. This case fits this definition of cardiac memory. == MY Comment , by K EN G RAUER, MD ( 11/9 /2023 ): == I found Dr. Baseline echocardiogram showed moderate LV systolic dysfunction with no wall motion abnormalities.

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ACEP Now

NOVEMBER 14, 2023

1 However, it is important to understand that death from hemoptysis is almost always due to hypoxia or asphyxiation (blood impedes gas exchange in the lungs, typically because of bleeding from high-pressure bronchial arteries into the lungs) as opposed to hemodynamic instability. These patients are at imminent risk of respiratory failure.

E-9-1-1 52

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

Dr. Smith's ECG Blog

NOVEMBER 30, 2022

The fire department, who operate at an EMT level in this municipality, arrived before us and administered 324 mg of baby aspirin to the patient due to concern for ACS. mm of ST segment elevation, V2 and V3 have 1 mm of elevation, v4 has 2 mm of elevation and v5 around 1.5 V1 has 0.5 mm of elevation. ng/mL [IQR: 0.46, 2.35].

Emergency Department 52

Emergency Department E-9-1-1 Coronary STEMI 52

AAEM RSA

APRIL 1, 2021

1 The American College of Surgeons’ (ACS) Trauma Quality Improvement Program (TQIP) Massive Transfusion in Trauma Guidelines leave a good amount of flexibility for hospitals regarding transfusion protocols, focusing more on systems-level aspects of designing and implementing MTPs.2,3 in the 1:1:1 group vs. 17.0%

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E-9-1-1 Plasma ACS ALS 52

Dr. Smith's ECG Blog

JULY 30, 2023

Obvious STEMI(+) OMI of inferior, posterior, and lateral walls, now with likely 2nd degree heart block type 1 (Wenckebach). STD maximal in V1-V4, without a QRS abnormality causing it, and in the setting of ACS symptoms, is posterior OMI until proven otherwise. In Figure-1 — The ST-T wave abnormality in lead V2 of ECG #1 is obvious.

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E-9-1-1 STEMI OR ED 52

Dr. Smith's ECG Blog

DECEMBER 13, 2019

Written by Pendell Meyers A man in his late 40s with several ACS risk factors presented with a chief complaint of chest pain. On review of systems the patient reported back pain for approximately 1 week which he was treating with NSAIDs with minimal relief. Here is his triage ECG: What do you think? Pericarditis?

E-9-1-1 52

E-9-1-1 ACS Coronary CAD 52

Dr. Smith's ECG Blog

DECEMBER 10, 2019

The pain is described as located in the midsternal area, radiating to the right arm, described as 8-9/10 and worse with deep inspirations. In the evening, he became diaphoretic and complained of 9/10 continuous chest pain. Today’s case provides perhaps the best example of s erial E CG e volution of this elusive entity.

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E-9-1-1 Coronary OR ACS 52

ECG & Echo Learning

OCTOBER 2, 2022

Most agents exhibit both vasopressor and inotropic effects (Figure 1). μg/kg/min Bolus : 1 mg IV every 3 to 5 min (max 0.2 mg/kg) IM: (1:1000): 0.1 mg (max 1 mg) Safe for peripheral use ++ + N/A Beta-effect more pronounced at low doses. μg/kg/min Bolus : 1 mg IV every 3 to 5 min (max 0.2 mg/kg) IM: (1:1000): 0.1

E-9-1-1 52

E-9-1-1 ALS Coronary Epinephrine 52

Dr. Smith's ECG Blog

OCTOBER 24, 2018

A 40-something male presented with dyspnea and left arm numbness, and perhaps some chest tightness, for 1 1/2 hours. Here is his triage ECG: There is massive STE in V3-V6, and also STE in II, III, aVF. This is all but diagnostic of STEMI, probably due to wraparound LAD The cath lab was activated. Suppose you had used the formula?

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E-9-1-1 STEMI ACS Coronary 52

Dr. Smith's ECG Blog

NOVEMBER 12, 2020

Here they are: Learning Points: 1. 7 These 3 studies, as well as 1 smaller meta-analysis, 6 and another small study, 8 make it clear that troponin is associated with increased severity and mortality in COVID when adjusted for multiple other variables. He remained supported on an intraaortic balloon pump. 3–8 Shi et al.

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E-9-1-1 STEMI Coronary ALS 52

EMDocs

JANUARY 11, 2024

The neurologic section was divided into (1) brain oxygenation, perfusion, edema, and intracranial pressure (ICP); (2) seizures and the ictal-interictal continuum (IIC); and (3) sedation and analgesia. Each small group identified topics, and then the topics were voted on by the entire panel. Instead, target 92-98%.

Critical Care 75

Critical Care E-9-1-1 OR ICU 75

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].

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

Dr. Smith's ECG Blog

AUGUST 3, 2017

There are two main etiologies of ischemic ST-depression: 1) subendocardial ischemia 2) reciprocal to ST-elevation in an opposite wall Here there are distinct R-waves with marked ST-depression throughout most of the precordium. Tips for recognizing Acute Posterior STEMI: 1. References: 1. This can help in confirmation.

STEMI 52

STEMI E-9-1-1 Coronary ALS 52

EMDocs

JANUARY 20, 2024

She describes the pain as left-sided, non-radiating, and 9/10 in severity. Answer: Takotsubo Cardiomyopathy 1-18 Background: Also known as transient apical ballooning syndrome, apical ballooning cardiomyopathy, stress-induced cardiomyopathy, stress cardiomyopathy, Gebrochenes-Herz syndrome, and broken-heart syndrome.

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E-9-1-1 EMS Coronary ACS 74

EMDocs

JANUARY 6, 2024

1 Indications for transplant include: Non-ischemic cardiomyopathy (49%) Ischemic cardiomyopathy (35%) Restrictive cardiomyopathy (4%) Retransplantation following failed prior transplant (3%) Hypertrophic cardiomyopathy (3%) Congenital heart disease (3%) Valvular cardiomyopathy (3%) The median survival after heart transplant is over 12 years.

EMS 63

EMS E-9-1-1 ACS Coronary 63

EMDocs

FEBRUARY 12, 2024

Introduction Arterial blood gas (ABG) or venous blood gas (VBG) testing is used to assess the pH and systemic carbon dioxide tension in patients, and, therefore, provide a more complete picture of their acid-base status than an isolated basic metabolic panel (BMP) (1). What alternative testing can be done in these circumstances?

Emergency Department 94

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

Don't Forget the Bubbles

SEPTEMBER 18, 2023

However, symptoms may also be non-specific, including irritability, headache, poor feeding, vomiting, or diarrhoea. The diagnosis is clinical and can be made by directly visualising erythema or bulging of the tympanic membrane. Treatment is mainly symptomatic with analgesia. A throat culture is the gold standard for confirming a bacterial infection.

Emergency Department 143

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

ACEP Now

NOVEMBER 7, 2023

1 Overall, survival is poor following cardiac arrest, and is affected by factors including age, comorbidities, witnessed arrest, early CPR, early defibrillation, and return of spontaneous circulation (ROSC). 2018;13(9):e0204169. Margey R, Browne L, Murphy E, et al. Emmerson AC, Whitbread M, Fothergill RT. 20(S1):S67.

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Defibrillator E-9-1-1 ALS Epinephrine 52