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First10EM Journal Club: January 2025

Broome Docs

European Journal of Internal Medicine , [link] You can listen to my 27-minute rant on Youtube here: [link] This multinational trial looked at a three-pronged diagnostic protocol in the ED for adults with suspected acute aortic syndromes. The protocol used the ADD score, a POCUS echo protocol and D-dimer to try and exclude AAS in the ED.

ED 101
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Another deadly triage ECG missed, and the waiting patient leaves before being seen. What is this nearly pathognomonic ECG?

Dr. Smith's ECG Blog

The patient was upgraded to the ICU for closer monitoring. showed that , when T-waves are inverted in precordial leads, if they are also inverted in lead III and V1, then pulmonary embolism is far more likely than ACS. looked at consecutive patients with PE, ACS, or neither. Kosuge et al. Witting et al. of controls.

E-9-1-1 139
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Beyond Ketamine: When to use Facilitated Intubation in the ED

EMDocs

However, RSI has never been shown to reduce the risk of aspiration in the ED (13) or during emergent OR cases (14). While RSI should remain the gold standard in the vast majority of patients in the ED, FI presents an additional technique to mitigate anatomic or physiologic risk. To date, ketamine has been the agent of choice (12).

ED 86
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A fascinating electrophysiology case. What is this wide complex tachycardia, and how best to manage it?

Dr. Smith's ECG Blog

Ischemia from ACS causing the chest discomfort, with VT another consequence (or coincidence)? Cardioversion will address the rhythm problem immediately, also if the chest discomfort subsides when SR is restored, ischemia from ACS becomes much less likely. This patient presented to the ED “after a couple of days of chest discomfort”.

Coronary 119
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A man in his 60s with syncope and ST depression. What does the ECG mean?

Dr. Smith's ECG Blog

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 124
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Diagnostic Errors, Revisited: Where Do We Go Wrong, and How Can We Change?

ACEP Now

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.

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A woman in her 50s with acute chest pain

Dr. Smith's ECG Blog

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