Don't Forget the Bubbles

OCTOBER 2, 2024

Children often spend many hours in the emergency department (ED) before being sent home or admitted. In this issue of Pediatrics , Leyenaar and colleagues reported on a trial to compare the effectiveness of direct admission to bypass their emergency departments. De Alwis AC, Kumar TS. Eur J Pediatr. 2024 Sep 30.

ALS 52

ALS Emergency Department ED ACS 52

Dr. Smith's ECG Blog

OCTOBER 4, 2010

He arrived in the emergency department hemodynamically stable. ACS would be highly unusual in a young athlete, and given the information on his race bib, one must first suspect that the abnormal ST elevation is due to demand ischemia, not ACS. On his bib it stated that he had a congenital heart disorder.

ACS 52

ACS Defibrillator Epinephrine STEMI 52

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 85

STEMI Coronary Heart Attack ACS 85

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). Other examples included patients transferred between services whose failure to include complete handover information led to other delays in care.

Emergency Department 52

Emergency Department ICU ALS ACS 52

Dr. Smith's ECG Blog

SEPTEMBER 3, 2023

This was sent by anonymous The patient is a 55-year-old male who presented to the emergency department after approximately 3 to 4 days of intermittent central boring chest pain initially responsive to nitroglycerin, but is now more constant and not responsive to nitroglycerin. It is unknown when this pain recurred and became constant.

Defibrillator 131

Defibrillator Coronary STEMI CPR 131

Dr. Smith's ECG Blog

NOVEMBER 4, 2022

Smith: If this is ACS (a big if), t his is just the time when one should NOT use "upstream" dual anti-platelet therapy ("upstream" means in the ED before angiography). History sounds concerning for ACS (could be critical stenosis, triple vessel), but differential also includes dissection, GI bleed, etc. Anything more on history?

Coronary 52

Coronary ACS STEMI ALS 52

Dr. Smith's ECG Blog

JANUARY 27, 2024

, tells us that we physicians do not need to even look at this ECG until the patient is placed in a room because the computer says it is normal: Validity of Computer-interpreted “Normal” and “Otherwise Normal” ECG in Emergency Department Triage Patients I reviewed this article for a different journal and recommended rejection and it was rejected.

STEMI 102

STEMI Coronary ACS ED 102

Don't Forget the Bubbles

JULY 5, 2023

Opioids do not cause ACS but they can exacerbate hypoxia in patients with ACS. A 6-year-old girl from Saudi Arabia was referred by her General Practitioner to the local emergency department. Mechanical or non-invasive ventilation : children with ACS may require ventilatory support.

E-9-1-1 126

E-9-1-1 ACS OR ICU 126

Dr. Smith's ECG Blog

OCTOBER 2, 2021

Because the patient's pain had resolved completely and cardiology had declined immediate intervention, the patient was admitted but continued to board in the emergency department. Approximately 4 hours after arrival, the patient was re-examined by the emergency physician. There is no age cut-off for ACS. Do NOT use them.

OR 52

OR ACS STEMI Coronary 52

EMDocs

FEBRUARY 12, 2024

Supplementing information from VBGs Unlike pH, PCO 2 , and HCO 3 , there are no correlations or conversions that reliably determine oxygenation status from a VBG (1, 10). Correlation and agreement between arterial and venous blood gas analysis in patients with hypotension-an emergency department-based cross-sectional study.

Emergency Department 94

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

Don't Forget the Bubbles

MAY 17, 2023

Patterns of parental online health information-seeking behaviour. Invasive bacterial infection in children with fever and petechial rash in the emergency department: a national prospective observational study. De Alwis AC, et al. Pruccoli J, et al. Eur J Pediatr. 2023 Apr 13. Yudianto B, et al. J Paediatr Child Health.

ALS 72

ALS ACS Emergency Department EMS 72

Dr. Smith's ECG Blog

APRIL 17, 2023

He had no symptoms of ACS. The remainder of his Emergency Department stay was uneventful. greater than 40mS, V1-V2" Meyers interpretation: I was sent this ECG with no clinical information whatsoever, and I responded: "Easily diagnostic of acute LAD occlusion." There are hyperacute T waves in V2-V5, I, II, aVL.

OR 52

OR STEMI ACS Emergency Department 52

ALiEM

OCTOBER 30, 2024

Bupe Allergy Buprenorphine induction has been the mainstay of emergency department treatment of opioid use disorder for more than a decade [11, 12]. Treating patients with SUD can be incredibly challenging, especially without a foundation in trauma-informed care principles [20]. DOI: Papudesi BN, Malayala SV, Regina AC.

E-9-1-1 161

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

Dr. Smith's ECG Blog

JANUARY 23, 2023

Submitted and written by Megan Lieb, DO with edits by Bracey, Smith, Meyers, and Grauer A 50-ish year old man with ICD presented to the emergency department with substernal chest pain for 3 hours prior to arrival. The screening physician ordered an EKG and noted his ashen appearance and moderate distress. Triage EKG: What do you think?

ACS 52

ACS Coronary Defibrillator STEMI 52

Pediatric EM Morsels

SEPTEMBER 20, 2024

Diarrhea is one of the most common complaints in the pediatric emergency department, especially in the summer and early fall. A thorough review of vital signs, physical exam findings and a complete blood count with differential, renal function panel and urinalysis offer valuable information in the patient being worked up for HUS.

Emergency Department 161

Emergency Department ACS ALS EMS 161

EMDocs

OCTOBER 21, 2023

The NIHSS cutoff that predicts outcomes is 4 points higher in AC compared with PC infarctions. While MRI is more resource and time intensive, studies have shown that a 6-minute protocol can give sufficient information to dictate treatment in the right setting. Arch Neurol. 2004;61(4):496–504. doi:10.1001/archneur.61.4.496 ResearchGate.

EMS 73

EMS ALS OR ACS 73

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 69

ED ACS Emergency Department OR 69

Dr. Smith's ECG Blog

NOVEMBER 26, 2015

52-year-old lady presents to the Emergency Department with 2 hours of chest pain, palpitations & SOB. Although not always available a prior ECG is probably the most helpful piece of information in these cases. Beware of ACS presenting with atypical symptoms, including absence of chest pain.

STEMI 52

STEMI ACS Emergency Department OR 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? I wouldn't activate the lab for this EKG alone, but if the patient is clinically compatible with ACS you could call a heart alert.

STEMI 52

STEMI Coronary OR ED 52

Dr. Smith's ECG Blog

FEBRUARY 5, 2019

When I saw this without any other information, I said it was very suspicious for a high lateral MI. 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.

STEMI 52

STEMI Emergency Department ED OR 52

AAEM RSA

DECEMBER 3, 2020

32 Relying on easily and rapidly obtained information, these simple and low-cost tools may be particularly useful in low resource settings and in cases where time or severity of patient presentation does not permit additional workup. Wysoki MG, Santora TA, Shah RM, Friedman AC. West J Emerg Med. West J Emerg Med.

Emergency Department 52

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

Dr. Smith's ECG Blog

NOVEMBER 12, 2020

Clin Chem [Internet] 2020;Available from: [link] Smith mini-review: Troponin in Emergency Department COVID patients Cardiac Troponin (cTn) is a nonspecific marker of myocardial injury. of Cardiology AC, Others. Cardiac Troponin Testing in Patients with COVID-19: A Strategy for Testing and Reporting Results.

E-9-1-1 52

E-9-1-1 STEMI Coronary ALS 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. Case 3 I was reading a stack of ECGs yesterday, and saw this one, with no clinical information.

STEMI 52

STEMI Coronary OR ALS 52

Dr. Smith's ECG Blog

JUNE 8, 2023

I sent the ECG to Dr. Meyers without any information, and he immediately replied, “inferior OMI.” As recurrent ischaemia is the principle event reduced by early intervention in NSTE-ACS, these are important endpoint events occurring with delayed angiography and there is a consistent signal for harm now from two data sources.”[5]

STEMI 63

STEMI Coronary Paramedic ALS 63

Dr. Smith's ECG Blog

APRIL 8, 2015

2) Boston syncope rule: J Emerg Med. full text link) Presence of any one of these 8 criteria had 97% sensitivity and specificity of 62% for adverse outcomes: 1) Signs of Acute Coronary Syndrome (ACS), 2) conduction disease, 3) worrisome cardiac history, (eg. The ROSE (Risk Stratification of syncope in the emergency department) Study.

Emergency Department 52

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