The Skeptics' Guide to EM

OCTOBER 5, 2019

Date: September 25th, 2019 Reference: Bath PM et al. Prehospital transdermal glyceryl trinitrate in patients with ultra-acute presumed stroke (RIGHT-2): an ambulance-based, randomized, sham-controlled, blinded, phase 3 trial. Date: September 25th, 2019 Reference: Bath PM et al. The Lancet March 2019. The Lancet March 2019.

Ambulance 130

Ambulance Paramedic EMS ALS 130

ACEP Now

JANUARY 4, 2025

I was about two months into a family practice internship when I went to visit my uncle whose neighbor happened to be an ED resident, Dr. Clarke said. Firsthand Account An ambulance bay at the LA County-USC Hospital in 1978. A cross-country move brought him to Delaware, where he served as the director of a hospital ED in Milford, Del.

ED 52

ED Emergency Department Ambulance CPR 52

The Skeptics' Guide to EM

JANUARY 19, 2019

Date: January 17th , 2019 Reference: Clemency et al. Date: January 17th , 2019 Reference: Clemency et al. This teaching has been challenged by a systematic review by Willman et al 2017. We reviewed the Willman et al publication on SGEM#179 and generally agreed with the authors’ conclusions. Reference: Clemency et al.

Naloxone 130

Naloxone Overdose Emergency Medical Services Emergency Department 130

The Skeptics' Guide to EM

MARCH 22, 2019

You have ambulances ramping and patients queuing at triage. You have ambulances ramping and patients queuing at triage. Research by Hill et al (1) demonstrated that an ED shift can have 4,000 clicks. SGEM#159 looked at the implementation of an EMR in a tertiary care ED. Case: The emergency department is backing up.

EMR 130

EMR Emergency Department Ambulance ED 130

The Skeptics' Guide to EM

APRIL 8, 2023

In Ontario alone there have been approximately 160 emergency departments (ED) temporarily closed since the beginning of 2022. The dataset also reported increasing admissions, mixed results on length of stay, increasing readmission rates, increasing COPD deaths if transported by ambulance, and expected productivity benefits were not realized.

Emergency Department 142

Emergency Department ED Ambulance ALS 142

EMDocs

JUNE 22, 2024

A 37-year-old G5P4 at 33 weeks presents to the ED after being brought in by ambulance. She had a precipitous delivery while the ambulance was pulling in. According to EMS, she was in labor at home and delivered the newborn shortly after they had loaded her into the ambulance. RR 28, SpO2 89% on 6L NC. link] j.ajog.2016.03.012

EMS 111

EMS FFP Ambulance ICU 111

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. In fact, Kosuge et al. Stein et al. This is a paper worth reading : Marchik et al. Kosuge et al.

E-9-1-1 139

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

The Skeptics' Guide to EM

APRIL 24, 2021

Reference: Martel et al. AEM April 2021 Case: You are sitting minding your own business charting on shift when you become aware of shouting and banging from your ambulance bay. Reference: Martel et al. Kirsty is also the creator of the wonderful infographics called #PaperinaPic.

Emergency Department 100

Emergency Department ALS Ambulance ED 100

EMDocs

NOVEMBER 21, 2023

Could not ambulate. In ED, repeat potassium level was 2.6 Permanent weakness usually affects the proximal lower extremities, happens in older patients, and develops late. Diagnosis: Can be made in the ED based on history, exam, lab testing. Consult neurology in the ED. Miller TM, Dias da Silva MR, Miller HA, et al.

E-9-1-1 95

E-9-1-1 ALS ED OR 95

EMS 12-Lead

JUNE 1, 2022

He advises, however, recurrent syncopal episodes for the past six months, some of which have resulted in ED admission, yet no identifying mechanism could be determined. Chou’s Electrocardiography in Clinical Practice (6th ed). Josephson’s Clinical Cardiac Electrophysiology: Techniques and Interpretations (6th ed). 2] Meyers, H.

Coronary 130

Coronary ALS ED ACS 130

The Skeptics' Guide to EM

JANUARY 7, 2023

Date: January 4th, 2023 Reference: Hasbrouck et al. Date: January 4th, 2023 Reference: Hasbrouck et al. Case: A 62-year-old male with a past medical history of heart failure with reduced ejection fraction presents to your emergency department (ED) via ambulance for palpitations and shortness of breath that started earlier that day.

OR 100

OR Emergency Department ALS Ambulance 100

Dr. Smith's ECG Blog

JUNE 5, 2023

A 40-something male presented by ambulance with one hour of chest pain that was improving after sublingual nitroglycerine and 325 mg of aspirin, chewed. Here is his initial ED ECG: What do you think? Or had not had a prehospital ECG on the ambulance. Then the ED doc would be dependent on that first ECG.

STEMI 96

STEMI Coronary ED Ambulance 96

ACEP Now

OCTOBER 9, 2023

The other night I stood in the trauma bay, listening to rain patter against the automatic doors, awaiting an ambulance. Kaufman EJ, Richmond TS, Wiebe DJ, et al. These days, I attempt to balance a less morally injurious trauma resuscitation with the need for rapid stabilization and treatment. 2017;152(9):843.

Heart Attack 126

Heart Attack Life Support Emergency Department Ambulance 126

ACEP Now

MAY 10, 2024

Patients often seek care in the emergency department (ED) setting when flares of pain affect their ability to ambulate, climb stairs, or even stand up from sitting. In our experience, patients have been able to ambulate comfortably with no motor deficits in approximately 30 minutes. Chronic knee pain is common and debilitating.

Emergency Department 92

Emergency Department Ambulance ED OR 92

Dr. Smith's ECG Blog

NOVEMBER 15, 2023

She was brought in by ambulance and received aspirin and nitroglycerin en route. link] Case continued She arrived in the ED and here is the first ED ECG. Lindahl et al. From Gue at al. Lindahl B, Baron T, Erlinge D, et al. This originally radiated into her left arm. She also had some shortness of breath.

Coronary 109

Coronary E-9-1-1 STEMI ACS 109

Don't Forget the Bubbles

JUNE 30, 2023

Grabbing a pristine white table napkin to apply pressure to the wound, Ranulf’s class teacher and expedition leader called the ambulance as chaos descended on the restaurant. All you know, back in ED, is that the ETA is 10 minutes, and there is a single stab wound to the chest. Back in ED with Ranulf, and pack two has gone through.

E-9-1-1 139

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

ACEP Now

JUNE 14, 2024

Transferring patients from one ED to another hospital is an established part of emergency medicine practice. 1 As fresh challenges of the pandemic and hospital operations changed emergency medicine practice, one of the more challenging areas was the movement of admitted patients out of the first emergency department (ED).

Emergency Department 52

Emergency Department ED Ambulance OR 52

EMDocs

JUNE 9, 2023

EMS Environment Ok, we’ve got the patient calmed down and gotten them into the ambulance. If you have restraints in your ambulance, are those restraints appropriately sized for pediatric patients? As usual, de-escalate whenever possible before resorting to physical or chemical restraints.

Emergency Medical Services 98

Emergency Medical Services EMS Emergency Department Ambulance 98

Dr. Smith's ECG Blog

MARCH 10, 2017

A 61 year-old with chest pain arrived to the ED by ambulance with resolving chest pain. Here is his ED ECG: The computer interpretation was " normal " What do you think? link] Hughes KE et al. This ECG is NOT normal. The T-waves in V2-V4 are very large in proportion to the QRS. They are suspicious for hyperacute T-waves.

STEMI 52

STEMI Ambulance ED ALS 52

ACEP Now

JUNE 7, 2023

The performance of EDs in 2020 and into 2021 changed abruptly, and that carried through into 2022. EDs weathered attacks from a variety of sources in recent years. ED leaders worked to develop new physician documentation and coding guidelines that needed to be implemented at the beginning of 2023.

Emergency Department 52

Emergency Department ED EMS Ambulance 52

Dr. Smith's ECG Blog

DECEMBER 19, 2023

The ambulance report says "BP continued to drop during transport and pt remained cold and clammy." Figure-2: Classification of Underlying Diagnoses in Patients with MINOCA ( Adapted from Table-1 in Sykes et al: Interventional Cardiology Review: 16:e10, 2021 ). After all, there is no S wave in lead V3.

E-9-1-1 127

E-9-1-1 Coronary ACS BLS 127

FOAMfrat

AUGUST 15, 2024

However, O- blood is always in such short supply that it is not feasible for it to be stocked in every ambulance, helicopter, and resuscitation bay. so I often overlook the simplistic act of turning on the heat in the ambulance, but it’s really important. In the ambulance or aircraft, at best, it’s you and your partner.

Plasma 69

Plasma Ambulance ALS Emergency Department 69

Dr. Smith's ECG Blog

OCTOBER 9, 2018

While in the ED, one patient progressed to have ECG changes consistent with STEMI although the initial triage ECG did not meet STEMI definition guidelines." They only looked at ED diagnosis, not at any angiogram or even at discharge diagnosis. In our ED, a health care assistant (HCA) records all ECGs, in triage and elsewhere.

STEMI 52

STEMI ED OR Ambulance 52

Dr. Smith's ECG Blog

NOVEMBER 2, 2015

The first (and only) ED ECG is here: QTc 386. Hildebrandt et al have proven that prehospital 12 Lead ECGs followed by an immediate call for reperfusion team mobilization reduce door to balloon times.We A second ECG was done prior to arrival at the ED. Physicians were worried and activated the cath lab. Hypothesis.

Paramedic 52

Paramedic STEMI ACS Ambulance 52

FOAMfrat

JANUARY 23, 2024

Having worked in the ED setting, I can attest that these skills can be extrapolated to a knowledgeable and experienced prehospital provider. Antibiotics serve as a potent weapon against the invading pathogens, halting their spread and preventing further organ dysfunction (Baghdadi et al.,

EMS 52

EMS Emergency Department ALS Ambulance 52

ACEP Now

JULY 7, 2023

Case A 91-year-old Russian-speaking female on dual-antiplatelet therapy presented to the ED via ambulance with a left-sided nosebleed. EMS placed her on non-rebreather at 10 L per minute due to the significant amount of bleeding through the nose, and brought her to the ED. References Prekker ME, et al. Joshi R, et al.

Emergency Medical Services 45

Emergency Medical Services ALS EMS OR 45

Dr. Smith's ECG Blog

MARCH 6, 2023

Study idea: We should look at all OMIs who had a chest CT and compare to all patients with Non-OMI pathology who had a contrast chest CT and have radiologists blindly interpret the perfusion of the myocardium The cardiology fellow came down to the ED and said: "What are you worried about? This ST depression?" 2022.08.750 Section 5.2.2,

OR 52

OR STEMI ED Critical Care 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? The nitro she took in the ambulance did not help. She also received an additional nitro in the ED after receiving aspirin and nitro via EMS. Case A 30 something y.o. I did not appreciate any significant ST elevation.

Coronary 40

Coronary STEMI EMS ACS 40

Dr. Smith's ECG Blog

OCTOBER 7, 2019

They did not have an ultrasound on the ambulance (some local crews are starting to utilize POC limited US in our service areas). See this paper by Smith et al. V4R in Right Ventricular MI As in the Smith study of lead V1 in RVMI, Kosuge et al. It was about a 7 minute transport time. They did not study lead V1.

STEMI 40

STEMI EMS Coronary ALS 40

The Skeptics' Guide to EM

DECEMBER 26, 2020

Date: December 18th, 2020 Reference: Hulme et al. He holds a Masters in Public Administration from the […] The post SGEM#313: Here Comes A Regular to the ED first appeared on The Skeptics Guide to Emergency Medicine. Date: December 18th, 2020 Reference: Hulme et al. Reference: Hulme et al.

ED 130

ED Emergency Department Emergency Medical Services ALS 130

EMDocs

NOVEMBER 16, 2024

1-3 Despite its commonality it retains a relatively high rate of complications overall and patients frequently present to the ED for evaluation. 10% of patient’s have an ED visit within 30 or 90 days following THA. An 80-year-old man with a history of hip arthroplasty presents by ambulance after falling at home.

EMS 98

EMS E-9-1-1 Operating Room Emergency Department 98

EMDocs

JULY 3, 2023

Louis); Alex Koyfman, MD (@EMHighAK); Marina Boushra, MD (EM-CCM Attending, Cleveland Clinic Foundation) Case A 62-year-old male with past medical history of hypertension (HTN), hyperlipidemia (HLD), and prior cerebrovascular accident (CVA) presents to the emergency department (ED) via ambulance. Glasgow coma scale (GCS) is 12.

ED 98

ED E-9-1-1 ALS OR 98

EMDocs

DECEMBER 18, 2023

F) in the ambulance. On arrival to the ED, her blood pressure is 84/36 mmHg with a heart rate of 110 beats per minute. 3,4 Prompt recognition and management of sepsis and septic shock are paramount for the ED clinician. The patient currently resides at a skilled nursing facility. She had a fever of 38.7 °C

E-9-1-1 91

E-9-1-1 ALS Emergency Department Plasma 91

Don't Forget the Bubbles

NOVEMBER 1, 2023

Ebenebe CU, Schriever K, Apostolidou S, et al. This group has developed a height-based guide for ETT insertion but recognise that measuring the height of a patient may not be feasible within an ED setting. Picard C, Abbo O, Munzer C, et al. Article 1: Do you have the right endotracheal tube? What’s it about? DOI: 10.1097/PEC.0000000000002890

Emergency Department 140

Emergency Department ALS OR Ambulance 140

ACEP Now

JUNE 14, 2024

4,11 Oral corticosteroids are as effective as intravenous steroids, but a one-time dose of intravenous methylprednisolone 125 mg in the ED is useful for patients who obviously cannot tolerate oral medications. Adeloye D, Song P, Zhu Y, et al. Canut A, Martín-Herrero JE, Labora A, et al. Howton JC, Rose J, Duffy S, et al.

ALS 52

ALS Coronary OR ED 52

FOAMfrat

NOVEMBER 21, 2024

Increasing cabin temperatures in your aircraft or ambulance might be uncomfortable for you, but important to your patient’s survival. upon ED arrival incur mortality rates of up to 3-5x that of patients without coagulopathy. Jessica Dawkins Mills BSN, et al. Current literature suggests that patients with INR > 1.2

ICU 119

ICU Emergency Department OR Ambulance 119

Dr. Smith's ECG Blog

DECEMBER 16, 2024

male who hasn't doctored in several years presented to the emergency department by ambulance for chief complaint of chest pain. An ED ECG was recorded: Very Similar Mild ST elevations in leads II, III, aVF with reciprocal changes in the lateral leads, along with ST elevation in V1 raising concern for RVMI. Case 2 A 50-something y.o.

STEMI 105

STEMI Coronary Critical Care ED 105