Dr. Smith's ECG Blog

OCTOBER 25, 2023

Moreover, the Queen is only supposed to be used with a high pretest probability of ACS/OMI. The patient was admitted to the ICU for close monitoring and electrolyte repletion and had an uneventful hospital course. We just finished training version 2 with some cases of hypokalemia, so that is in the future. As per Drs.

Overdose 112

Overdose ACS OR ICU 112

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). percent of ED visits resulted in preventable death as result of diagnostic error. Further diagnostic testing in the ICU identified salicylate toxicity.

Emergency Department 52

Emergency Department ICU ALS ACS 52

Dr. Smith's ECG Blog

JANUARY 6, 2023

The patient vomited once and given the more intense pain decided to come to the ED. Smith comment: We have shown that use of opiates is associated with worse outcomes in ACS: Bracey, A. 2-hour hsTn: 615 ng/L; bedside ED echo (without contrast) did not show a clear wall motion abnormality (WMA). Abstract 556.

ACS 52

ACS Coronary ICU STEMI 52

Don't Forget the Bubbles

JUNE 30, 2023

All you know, back in ED, is that the ETA is 10 minutes, and there is a single stab wound to the chest. The ODP is caught up leaving theatres and has not yet made it down to ED. They found NO difference in drain failure rates ( 11% pigtail vs 13% chest tube P=0.74), total daily volume drained or length of ICU stay between groups.

E-9-1-1 139

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

REBEL EM

FEBRUARY 2, 2023

Background Information: Atrial fibrillation with rapid ventricular rate (RVR) is one of the many tachydysrhythmias we encounter in the Emergency Department (ED). 2 Amiodarone is commonly known for its anti-arrhythmic properties and a commonly used agent in the Intensive Care Unit (ICU).

Emergency Department 52

Emergency Department ALS Critical Care ED 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 ACS TQIP Best Practice Guidelines. 248(3):447-58.

E-9-1-1 52

E-9-1-1 Plasma ACS ALS 52

Dr. Smith's ECG Blog

MARCH 6, 2019

She did not receive any opioids (which would mask her pain without affecting any underlying ACS). She was asymptomatic at the time of this ECG recorded on arrival to our ED: What do you think? By the time the patient arrived at our facility, she had received aspirin and nitroglycerin, and her pain had apparently completely resolved.

STEMI 52

STEMI ALS ACS OR 52

EMDocs

OCTOBER 21, 2023

The NIHSS cutoff that predicts outcomes is 4 points higher in AC compared with PC infarctions. Median time from ED arrival to diagnosis was 8 hours 24 min in one study, with only 19% being diagnosed within the 4.5-hour Post TW, ed. NIHSS does have limitations when applied to posterior circulation (PC) strokes. Neurohospitalist.

EMS 75

EMS ALS OR ACS 75

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. The cardiologists felt that the ECG did not represent ACS, and thought it was more likely pericarditis, so they did not take him to the cath lab. in the ICU but survived with excellent function.

E-9-1-1 52

E-9-1-1 ACS Coronary CAD 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. References Deshwal H, Sinha A, Mehta AC. 6 Position the patient with the head of the bed at 30 to 45 degrees during intubation whenever possible, and use an 8.5 A special thanks to Drs. 2021;42(1):145-159.

E-9-1-1 52

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

REBEL EM

JULY 14, 2022

An example using a real case I had while on call in the ICU: A 61-year-old female had a post-induction arrest on the wards/hospital telemetry floor after being intubated for airway protection. PMID: 30060961 Koller AC, et al. In a PCAC 1 or 2, we may prioritize a cath and tolerate a couple hours without ICU Neuroresuscitation.

ICU 52

ICU ALS OR CPR 52

Dr. Smith's ECG Blog

APRIL 20, 2018

This is her pre-hospital ECG: This is her first ECG in the ED: What do you think? She also received an additional nitro in the ED after receiving aspirin and nitro via EMS. I took part in her ICU care and she was extubated and stable to transfer to a stepdown unit after a few days. Case A 30 something y.o.

Coronary 40

Coronary STEMI ACS EMS 40

Dr. Smith's ECG Blog

MARCH 11, 2019

The patient was managed in the ICU and had serial troponins. An angiogram confirmed ACS as the etiology. Figure-1: The first 2 ECGs shown in this case ( See text ). == C OMMENT : As per Dr. Smith — E CG # 1 was the initial tracing on this patient who presented to the ED already intubated for respiratory failure. First was 2.9

OR 52

OR ACS ICU STEMI 52

ALiEM

OCTOBER 30, 2024

Our experience: Traditionally, ED physicians do not like ordering urine drug screens (UDS). We have certainly seen patients who have pain which is controlled and still have psychomotor agitation and sympathetic activation, leading some to require ICU admission for dexmedetomidine and/or ketamine infusion. 2023 Aug 1;89(2):231.

E-9-1-1 161

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

EMDocs

FEBRUARY 12, 2024

As the only respiratory therapist in the ED has been paged and is starting BiPAP for this patient, an overhead call for two incoming trauma alerts from a multivehicle collision sounds. Because the RT responsible for drawing arterial blood gases is busy caring for these patients, ABGs will be delayed.

Emergency Department 94

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

EMDocs

JANUARY 6, 2024

A 64-year-old male presents by EMS to the ED with shortness of breath. 1 There are over 50,000 visits related to heart transplant in the United States each year and over half of these patients are admitted to the hospital from the ED. We’ll keep it short, while you keep that EM brain sharp.

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). During a 6-month period, paediatric patients (< 18 years old) who underwent tracheal intubation in their ED were included in the study.

CPR 52

CPR Emergency Department ALS ICU 52