The Skeptics' Guide to EM

MAY 25, 2019

Robert Edmonds is an emergency physician in the US Air Force in Virginia. The American College of Emergency Physicians (ACEP) and American College of Surgeons Committee on Trauma (ACS COT) in 2018 put out a joint statement for the use of REBOA [4]. This is Bob’s tenth visit to the SGEM.

ACS 130

ACS Emergency Department ALS OR 130

ALiEM

AUGUST 30, 2024

A 5-year-old female presented to the emergency department (ED) with a one-year history of gradually increasing anterior neck swelling. Jonklaas J, Bianco AC, Bauer AJ, Burman KD, Cappola AR, Celi FS, Cooper DS, Kim BW, Peeters RP, Rosenthal MS, Sawka AM; American Thyroid Association Task Force on Thyroid Hormone Replacement.

ACS 161

ACS Emergency Department ED OR 161

Dr. Smith's ECG Blog

JUNE 17, 2024

Written by Bobby Nicholson, MD 67 year old male with history of hypertension and hyperlipidemia presented to the Emergency Department via ambulance with midsternal nonradiating chest pain and dyspnea on exertion. Pain improved to 1/10 after EMS administers 324 mg aspirin and the following EKG is obtained at triage. What do you think?

E-9-1-1 139

E-9-1-1 ACS Emergency Department Coronary 139

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. Predicting Adverse Outcomes for Shiga Toxin-Producing Escherichia coli Infections in Emergency Departments. Diagnostic criteria can still be met up to 13-14 days out. 2021 May;232:200-206.e4.

Emergency Department 164

Emergency Department ACS ALS EMS 164

The Skeptics' Guide to EM

FEBRUARY 27, 2021

Rapid Administration of Methoxyflurane to Patients in the Emergency Department (RAMPED): A Randomised controlled trial of Methoxyflurane vs Standard care. […] The post SGEM#320: The RAMPED Trial – It’s a Gas, Gas, Gas first appeared on The Skeptics Guide to Emergency Medicine. Reference: Brichko et al. Reference: Brichko et al.

Emergency Department 130

Emergency Department ACS ALS ED 130

Dr. Smith's ECG Blog

OCTOBER 26, 2010

He presented to the Emergency Department with a blood pressure of 111/66 and a pulse of 117. ACS and STEMI generally do not cause tachycardia unless there is cardiogenic shock. Then ACS (STEMI) might be primary; this might be cardiogenic shock. One must clearly rule out these processes before jumping on the ACS diagnosis.

ACS 52

ACS STEMI OR Critical Care 52

EM Didactic

JANUARY 27, 2019

Myth 1 Absence of Classic Chest Pain obviates the need for ACS work up The absence of chest pain in no way excludes the diagnosis of ACS. Around 33-50% of the patients with ACS present to the hospital without chest pain. Close to 20% of patients diagnosed with acute MI present with symptoms other than chest pain.

ACS 52

ACS ALS Coronary Emergency Department 52

The Skeptics' Guide to EM

JULY 2, 2022

Corey Heitz is an emergency physician in Roanoke, Virginia. He is also the CME editor for Academic Emergency Medicine. Corey Heitz is an emergency physician in Roanoke, Virginia. He is also the CME editor for Academic Emergency Medicine. If we thought about ACS, we brought them in. AEM June 2022.

Coronary 100

Coronary Heart Attack ACS CAD 100

Dr. Smith's ECG Blog

OCTOBER 20, 2024

The ST segment changes are compatible with severe subendocardial ischemia which can be caused by type I MI from ACS or potentially from type II MI (non-obstructive coronary artery disease with supply/demand mismatch). The patient was rushed to the nearest emergency department (non-PCI facility) for stabilization.

Coronary 128

Coronary ACS Emergency Department Epinephrine 128

ESO

FEBRUARY 11, 2025

In this first exploration of time to transfer data, ESO considered time to transfer for emergency department patients, time to transfer for inpatient patients, and if trauma center level mattered. Delays from communication breakdowns, logistical issues, or procedural bottlenecks can make the difference between life and death.

Emergency Department 105

Emergency Department ACS OR 105

The Skeptics' Guide to EM

SEPTEMBER 11, 2021

She arrives in the emergency department (ED) with decreased level of consciousness and shock. Acute coronary syndrome (ACS) is responsible for the majority (60%) of all OHCAs in patients. The paramedics achieve return of spontaneous circulation (ROSC) after CPR, advanced cardiac life support (ALCS), and Intubation.

EMR 130

EMR Coronary Defibrillator Life Support 130

EMS 12-Lead

APRIL 14, 2022

It should be emphasized here that this is a presentation of high-pretest probability for Acute Coronary Syndrome (ACS). ACE inhibitors, or potassium-sparing diuretics), are particularly susceptible. In the case of ACS, the ECG can rapidly change from this. Western Journal of Emergency Medicine, 18 (4), 752-760. [2]

ACS 130

ACS Paramedic Coronary ALS 130

The Skeptics' Guide to EM

MAY 28, 2022

Guidelines for Reasonable and Appropriate Care in the Emergency Department (GRACE) 2: Low-Risk, Recurrent Abdominal Pain in the Emergency Department. Guidelines for Reasonable and Appropriate Care in the Emergency Department (GRACE) 2: Low-Risk, Recurrent Abdominal Pain in the Emergency Department.

Emergency Department 100

Emergency Department ACS ALS Coronary 100

Dr. Smith's ECG Blog

MARCH 14, 2024

Case 1: Case 2: Case 3: Triage ECGs labeled ‘normal’ There have been a number of small studies suggesting that triage ECGs labeled ‘normal’ are unlikely to have clinical significance, and therefore that emergency physicians should not be interrupted to interpret them, and that such patients can safely wait to be seen.

STEMI 119

STEMI ACS Coronary Emergency Department 119

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 Epinephrine Defibrillator STEMI 52

EM Didactic

OCTOBER 7, 2018

It is commonly used in Emergency Departments, especially in febrile and possibly infectious patients. ACS and Aortic Dissection - For ACS and Dissection, the higher CRP levels, the worse prognosis. It is not used to diagnose ACS/Dissection. The value of C-reactive protein in emergency medicine.

Emergency Department 40

Emergency Department ACS Critical Care Coronary 40

The Skeptics' Guide to EM

MAY 29, 2021

The patient is an adult male with a gunshot wound to the chest, and they’re combative with emergency medical services (EMS). According to a recent study in the Journal of Surgical Research [3] , 44% of all penetrating thoracic trauma patients presented to a non-trauma center (not a level 1 or level 2 ACS defined trauma center).

Emergency Medical Services 130

Emergency Medical Services ACS ALS Emergency Department 130

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). Amiodarone versus digoxin for acute rate control of atrial fibrillation in the emergency department. Am J Emerg Med. Paper: Mason JM, et al.

Emergency Department 52

Emergency Department ALS Critical Care ED 52

Don't Forget the Bubbles

SEPTEMBER 13, 2023

The parents of 18-month-old Susie brought her to the Emergency Department after she had a seizure at home. Each article will take a deeper dive into each recommendation’s supporting evidence and practical implications. She has had two days of coryzal symptoms and fever. What is the evidence for avoiding imaging?

E-9-1-1 131

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

Dr. Smith's ECG Blog

MAY 20, 2024

In SCAPE (sympathetic crashing acute pulmonary edema), Emergency providers seem now to regularly give high dose NTG, but when the BP is 170/105 in a patient who is not crashing, we often fail to give something to lower afterload. __ Here are some Images: The red circle shows the LAD coursing down the anterior interventricular sulcus.

CAD 126

CAD STEMI Coronary ACS 126

Broome Docs

DECEMBER 22, 2024

Pediatr Emerg Care. PECARN looks at probiotics for toddlers diarrhea… Schnadower D, Tarr PI, Casper TC, Gorelick MH, Dean JM, O’Connell KJ, Mahajan P, Levine AC, Bhatt SR, Roskind CG, Powell EC, Rogers AJ, Vance C, Sapien RE, Olsen CS, Metheney M, Dickey VP, Hall-Moore C, Freedman SB. N Engl J Med. 2024 Oct 31. 2024 Aug 15.

E-9-1-1 52

E-9-1-1 ACS Paramedic Emergency Department 52

EMDocs

OCTOBER 8, 2024

Regarding emergent underlying causes, it may be helpful to think of etiologies of tachycardia as anything that could cause a need for increased cardiac output. At this point there are two large questions. #1. Am I missing anything? #2. What is this patient’s disposition? The Mental Model: A mental model for sinus tachycardia can assist.

E-9-1-1 105

E-9-1-1 Emergency Department ED ALS 105

ACEP Now

JUNE 6, 2023

Notoriously elusive, with a high misdiagnosis rate, thoracic aortic dissection (AD) can mimic many conditions, including acute coronary syndrome (ACS, the most common), gastroesophageal reflux disease (GERD), stroke, and spinal-cord compression. The patient is admitted for ACS to a cardiologist who says he will see the patient in the morning.

ACS 85

ACS ALS ED Coronary 85

Dr. Smith's ECG Blog

FEBRUARY 14, 2024

A 41-year-old male who presents to the emergency department with chest pain. The faculty physician thought this is highly likely to be ACS. Patient reports approximately 2 hours prior to arrival he developed a sharp chest pain that radiates into his left arm and left lower leg. Describes the radiating pain as numbness/tingling.

ACS 111

ACS Emergency Department OR 111

NCOAE

DECEMBER 11, 2023

The National Registry of Emergency Medical Technicians (NREMT) defines the term “spinal immobilization” as the use of adjuncts (LSB, cervical collar, etc.) In nearly all of my transports to the emergency department of a patient on a long spine board, it was removed almost immediately by the physician.

OR 52

OR Emergency Medical Technician Emergency Department Emergency Medical Services 52

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

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. Upon arrival to the emergency department, a senior emergency physician looked at the ECG and said "Nothing too exciting." V1 has 0.5

Emergency Department 52

Emergency Department E-9-1-1 Coronary STEMI 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 135

Defibrillator Coronary STEMI CPR 135

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 117

STEMI Coronary ACS ED 117

Dr. Smith's ECG Blog

OCTOBER 12, 2024

A man in his 90s with a history of HTN, CKD, COPD, and OSA presented to the emergency department after being found unresponsive at home. Vital signs were within normal limits on arrival to the Emergency Department. Written by Bobby Nicholson What do you think of this “STEMI”? Blood glucose was not low at 162 mg/dL.

STEMI 116

STEMI Coronary Emergency Department ACS 116

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 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 107

STEMI Coronary Heart Attack ACS 107

EMS 12-Lead

APRIL 21, 2022

He reports to staff that for the past two months, approximately, he has experienced intermittent dyspnea on exertion when walking the dog, particularly when scaling an incline. He admits to a mostly sedentary lifestyle, however denies any smoking, orthopnea, paroxysmal nocturnal dyspnea, or peripheral edema. Here is the time-zero ECG (0939 hours).

Coronary 130

Coronary ALS OR ACS 130

REBEL EM

FEBRUARY 12, 2024

There are greater than 2 million annual emergency department visits for suspected renal colic in the US, and Ct scanning is performed for more than 90% of patients who receive a diagnosis of kidney stone. PMID: 25229916 DOI: 10.1056/NEJMoa1404446 Westphalen AC, Hsia RY, Maselli JH, Wang R, Gonzales R. N Engl J Med.

Emergency Department 77

Emergency Department ALS ACS EMS 77

EMDocs

SEPTEMBER 25, 2023

However, emergency physicians have recently faced a multitude of patients requiring ETI with anatomically and physiologically difficult airways; these patients increase the risk of a can’t intubate/can’t oxygenate scenario or significant hypoxemia, hypercarbia, or acidemia. Paradoxical reactions (i.e., agitation or aggression).

ED 92

ED Emergency Department ALS Paramedic 92

Don't Forget the Bubbles

JUNE 30, 2023

You ask your anaesthetist to get ready to sedate or intubate depending on their status – Significant risk to the department – you make sure security is aware And your patient arrives. Ranulf is quite a sweet, round-faced boy, accompanied by his traumatised-looking mother as he is wheeled to your trauma bay.

E-9-1-1 139

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

Dr. Smith's ECG Blog

APRIL 18, 2024

Written by Jesse McLaren A 70 year old with prior MIs and stents to LAD and RCA presented to the emergency department with 2 weeks of increasing exertional chest pain radiating to the left arm, associated with nausea. 1] European guidelines add "regardless of biomarkers". But only 6.4%

STEMI 121

STEMI Coronary ALS CAD 121