The Skeptics' Guide to EM

SEPTEMBER 11, 2021

Date: September 8th, 2021 Reference: Desch et al. Date: September 8th, 2021 Reference: Desch et al. He is interested and experienced in healthcare informatics, previously worked with ED-directed EMR design, and is involved in the New York City Health and Hospitals Healthcare Administration Scholars Program (HASP).

EMR 130

EMR Coronary Defibrillator Life Support 130

Dr. Smith's ECG Blog

SEPTEMBER 11, 2024

Here is the case: Report from EMS was witnessed syncope, his son did CPR, but the patient had pulses when EMS arrived. When the patient arrived in the ED, he was still hypotensive in 70s, slowly improving with EMS fluids. Here is the ED ECG (a photo of the paper printout) What do you think? No Chest Pain, but somnolent.

EMS 114

EMS CPR ED Coronary 114

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. ED attendings Dr. Gerald Whelan and Dr. Shumary Chow supervising a full arrest in C booththe main trauma roomwith an ED tech administering CPR. Click to enlarge.)

ED 52

ED Emergency Department Ambulance CPR 52

The Skeptics' Guide to EM

NOVEMBER 13, 2021

Date: November 10th, 2021 Reference: Andersen, et al: Effect of Vasopressin and Methylprednisolone vs Placebo on Return of Spontaneous Circulation in Patients With In-Hospital Cardiac Arrest. Case: A code blue is called for a 71-year-old male in-patient that is boarding in the emergency department (ED). JAMA Sept 2021. JAMA Sept 2021.

Epinephrine 100

Epinephrine Critical Care Life Support Emergency Department 100

The Skeptics' Guide to EM

NOVEMBER 16, 2019

Date: November 6th, 2019 Reference: Lascarrou et al. Date: November 6th, 2019 Reference: Lascarrou et al. Case: A 59-year-old woman comes is brought into your emergency department (ED) by EMS in cardiac arrest. She had a witnessed arrest, and CPR was initiated by bystanders. Reference: Lascarrou et al.

ALS 100

ALS CPR ICU EMS 100

Don't Forget the Bubbles

JUNE 19, 2024

Well-designed multicentre large studies in children were warranted; cue Leonard et al. CASP checklist for Clinical Prediction Rule (CPR) studies Is CPR clearly defined? A proportion of participants were missed because the ED provider refused enrollment or said “Other,” but this is not well described.

CPR 124

CPR Operating Room OR Emergency Department 124

ACEP Now

DECEMBER 6, 2024

After resuming CPR and administering an additional 400 mcg IV NTG, the patient achieved return of spontaneous circulation with sinus tachycardia. Dr. Rad is ED faculty at Wellstar Kennestone Regional Medical Center in Marietta, Ga., References Prinzmetal M, Kennamer R, Merliss R, et al. Myerburg RJ, Kessler KM, Mallon SM et al.

Coronary 98

Coronary Life Support ALS Emergency Department 98

Dr. Smith's ECG Blog

JULY 14, 2023

A 40-something with persistent Ventricular Fibrillation presented after attempted prehospital resuscitation A 40-something with no previous cardiac history presented to the ED in persistent Ventricular Fibrillation after attempted prehospital resuscitation. Finally, head-up CPR (which was not used here), makes for better resuscitation.

E-9-1-1 98

E-9-1-1 Defibrillator CPR STEMI 98

EMDocs

NOVEMBER 6, 2023

This post will focus on the key parts of the guideline that affect ED evaluation and management. Editorial Comment : Use standard BLS/ALS measures, especially if in cardiac arrest. Top 10 Take Home Pearls 1. COR 1, LOE C-LD. COR 1, LOE C-EO. COR 2a, LOE B-NR.

Naloxone 115

Naloxone OR BLS Overdose 115

ACEP Now

NOVEMBER 7, 2023

A 67-year-old man presents to the emergency department (ED) in cardiac arrest. On ED presentation, he is unresponsive and the monitor shows ventricular fibrillation. References Go AS, Mozaffarian D, Roger VL, et al. Larribau R, Deham H, Niquille M, et al. Margey R, Browne L, Murphy E, et al. Circulation.

Defibrillator 52

Defibrillator E-9-1-1 ALS Epinephrine 52

NCOAE

AUGUST 12, 2022

Here, we present them in alphabetical order: ABC – Airway, Breathing and Circulation – “This is the Golden Rule of emergency medical professionals” AED – Automated External Defibrillator – The device that delivers electric shock to the heart of patients experiencing sudden cardiac arrest A-EMT – Advanced EMT ALS – Advanced Life Support Anaphylaxis— (..)

EMS 52

EMS EMT EMT Emergency Medical Technician 52

Don't Forget the Bubbles

JUNE 17, 2024

The Importance of Civility in Critical Care Resuscitation A 3-year-old patient with diabetic ketoacidosis arrives at your ED. A third RCT demonstrated that even brief low-level incivility could increase the risk of major error during CPR by up to 66%. Frich JC, Brewster AL, Cherlin EJ, Bradley EH. British journal of nursing.

E-9-1-1 105

E-9-1-1 Critical Care CPR ICU 105

Dr. Smith's ECG Blog

OCTOBER 28, 2013

It was witnessed, and CPR was performed by trained individuals. She arrived in the ED 37 minutes after 911 was called, with continuing CPR. She arrived in the ED 37 minutes after 911 was called, with continuing CPR. The following 12-lead ECG was recorded at 11 minutes after ROSC. at the time of the ECG.

Defibrillator 52

Defibrillator ACS CPR STEMI 52

Dr. Smith's ECG Blog

JUNE 11, 2021

Jesse McLaren (@ECGcases), of Emergency Medicine Cases Reviewed by Pendell Meyers and Steve Smith An 85yo with a history of hypertension developed chest pain and collapsed, and had bystander CPR. The patient was brought to the ED as a possible Code STEMI and was seen directly by cardiology. Vitals were HR 58 BP 167/70 R20 sat 96%.

EMR 52

EMR STEMI CPR ED 52

Dr. Smith's ECG Blog

NOVEMBER 30, 2019

They transported to the ED. The history, obtained subsequently, is interesting: The patient had been seen at an outside ED 2 days prior and the K was 2.5 Hospital admission had been recommended, but she left that ED against medical advice. the associated loss is double, at 200-400 mEq.* [ Sterns RH, et al.

Plasma 40

Plasma STEMI Defibrillator Overdose 40

EMS 12-Lead

MAY 15, 2024

In this call, paramedics arrived on scene to find a patient apneic and pulseless with CPR in progress by first responders (AED had an unknown unshockable rhythm). Patient had an unwitnessed cardiac arrest without bystander CPR performed. Pacing was continued in the ED, with identical settings. Several learning points here.

Epinephrine 331

Epinephrine Paramedic CPR EMT 331

EMS 12-Lead

MARCH 30, 2024

The paramedics begin CPR. CPR is performed with manual compressions as no mechanical CPR device is available. They are unable to feel a pulse and resume CPR. On ED arrival ROSC is achieved. Suddenly, the patient has a bowel movement and becomes pulseless / apneic. Intubation is attempted, but unsuccessful.

CPR 312

CPR Paramedic Ambulance Defibrillator 312

REBEL EM

JUNE 29, 2023

Available at: HERE Branch KHR et al. The CT FIRST Trial: Should We Pan-CT After ROSC?, REBEL EM Blog, June 1, 2023. Diagnostic yield, safety, and outcomes of Head-to-pelvis sudden death CT imaging in post arrest care: The CT FIRST cohort study.

CPR 145

CPR ICU EMS ALS 145

Don't Forget the Bubbles

JUNE 30, 2023

She was intubated at the scene and transported to your ED, with cardiopulmonary resuscitation (CPR) performed en route. Despite good quality CPR, there is no ROSC. Despite good quality CPR, there is no ROSC. Despite good quality CPR, there is no ROSC. Mazur P, Kosinski S, Podsiadlo P, et al.: Meert et al.

CPR 145

CPR Life Support Critical Care ALS 145

EMDocs

JANUARY 16, 2024

Louis) // Reviewed by: Alex Koyfman, MD (@EMHighAK); Brit Long, MD (@long_brit) Case You are working in the trauma/critical care pod of your emergency department (ED). His blood sugar was normal en route to the ED, and his initial rhythm on the cardiac monitor was asystole. Carsten L, et al. It is unclear how long he was down.

Defibrillator 109

Defibrillator CPR Epinephrine Life Support 109

Don't Forget the Bubbles

MAY 3, 2023

Forestell B, Battaglia F, Sharif S, et al. Prekker ME, Bjorklund AR, Myers C, et al. 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). O’Connell et al. Crit Care Explor.

CPR 52

CPR Emergency Department ALS ICU 52

ACEP Now

OCTOBER 11, 2024

Optimally, bystander CPR, including the administration of rescue breaths, should be initiated prior to arrival of emergency medical services. ED treatment should focus on airway, breathing, and circulation with consideration for cervical spine protection depending on the circumstances surrounding the event. South Med J. Ital J Pediatr.

ALS 52

ALS Emergency Department Emergency Medical Services ED 52

EMDocs

MARCH 20, 2024

Here’s another case from Medical Malpractice Insights – Learning from Lawsuits , a monthly email newsletter for ED physicians. “Code,” “No Code,” “CPR,” “resuscitation,” etc. References : Ouchi K et al. To opt in to the free subscriber list, click here. You might like it.

CPR 106

CPR ALS OR ED 106

Don't Forget the Bubbles

JULY 26, 2023

Prioritise listening to the first 30 minutes which given a good overview of aetiology and treatment (53 mins) Basics of cardiac rhythm problems in the ED Palpitations are a common reason for children to present to the emergency department, the majority of these will be benign from a cardiac perspective and instead related to stress or anxiety.

ALS 98

ALS ED OR CPR 98

Dr. Smith's ECG Blog

NOVEMBER 19, 2014

See this paper by Widimsky et al, which shows the high association of RBBB, especially with LAFB, with LAD occlusion. So this is diagnostic of proximal LAD occlusion. New RBBB + LAFB is a very bad sign. It is highly associated with proximal LAD occlusion and bad outcomes.

CPR 52

CPR STEMI Coronary ALS 52

Dr. Smith's ECG Blog

MARCH 11, 2016

Her prehospital ECG was identical to her first ED ECG, and the cath lab was activated: There is massive ST elevation (greater than 15 mm) in V2 and V3, with ST elevation in I and aVL and reciprocal ST depression in II, III, aVF. Raitt MH, et al. Methods: Oliva et al. (94) Methods: Oliva et al. hours when she called 911.

ALS 52

ALS STEMI OR ED 52

Dr. Smith's ECG Blog

NOVEMBER 12, 2020

This is a 30-something healthy patient presented with COVID pneumonia who presented to the ED. He underwent CPR, and regained a pulse after epinephrine, with an organized narrow complex rhythm at 140, but still with severe shock. 3–8 Shi et al. Sandoval Y, Smith SW, Sexter A, et al. Shi S, Qin M, Shen B, et al.

E-9-1-1 52

E-9-1-1 STEMI Coronary ALS 52

Dr. Smith's ECG Blog

FEBRUARY 8, 2022

On arrival, CPR was continued and core temperature was measured at 18° C (64.4° The patient was put on Extracorporeal Life Support in the ED 3 hours after initial resuscitation, the core temp was 30° C and the patient was defibrillated with a single attempt. Rituparna et al — as well as Chauhan and Brahma ( Int.

CPR 40

CPR Defibrillator Life Support ED 40

REBEL EM

JULY 14, 2022

Paper: Nassal MMJ, et al. REFERENCES: Nassal MMJ, et al. PMID: 34968531 Rittenberger JC, et al. PMID: 21756969 Coppler PJ, et al. PMID: 25636896 Schober A, et al. PMID: 27368428 Elmer J, et al. PMID: 30060961 Koller AC, et al. Resuscitation. 2022 Mar; 17. Resuscitation. 2022 Mar; 17. Resuscitation.

ICU 52

ICU ALS OR CPR 52

REBEL EM

NOVEMBER 20, 2023

Paper: Jansen JO, Hudson J, Cochran C, et al. The enrolled population was severely injured, with a median ISS of 41, and 23% received CPR. The trial reported a median time of 32 minutes from ED arrival to successful balloon inflation. References: Butler FK Jr, Holcomb JB, Shackelford SA, et al. J Spec Oper Med.

OR 91

OR Emergency Medical Technician CPR ALS 91

Don't Forget the Bubbles

MAY 10, 2023

They’re getting CPR. There were 15 doctors and nurses from three paediatric EDs. Hot debriefs It’s clear that hot debriefs are valued by experienced ED staff and help reduce emotional toil. And then head back to the paeds ED. You’ve heard the phrase code black before – it’s a traumatic cardiac arrest. Take a break.

Emergency Department 91

Emergency Department ED CPR OR 91

Dr. Smith's ECG Blog

AUGUST 9, 2019

Smith and Meyers answer: First , LM occlusion is uncommon in the ED because most of these die before they can get a 12-lead recorded. She had a proven 100% Left Main occlusion No ST shift in aVR This pattern of RBBB/LAFB was also the most common pattern in Fiol et al. Widimsky P et al. Knotts et al. References 7.

Coronary 52

Coronary STEMI ACS ALS 52

EMDocs

JANUARY 17, 2024

She received cardiopulmonary resuscitation (CPR) and standard advanced cardiovascular life support (ACLS). She had return of spontaneous resuscitation (ROSC) and was subsequently intubated and transported to the emergency department (ED). Upon ED arrival, she had a heart rate (HR) of 160 and blood pressure (BP) of 80s/40s.

E-9-1-1 88

E-9-1-1 Overdose Emergency Medical Services Life Support 88

Dr. Smith's ECG Blog

SEPTEMBER 16, 2015

The patient arrived in the ED and had this ECG recorded: Interpretation? See this paper by Widimsky et al, which shows the high association of RBBB, especially with LAFB, with LAD occlusion. But the clinical history is not compatible with STEMI, so one must be very cautious about the ECG interpretation.

STEMI 40

STEMI CPR CAD Coronary 40

Dr. Smith's ECG Blog

OCTOBER 20, 2013

Medics found her apneic and pulseless, began CPR, and she was found to be in asystole. She was hypotensive in the ED and her bedside echo showed a normal RV and LV. Two prehospital 12-lead ECGs looked similar to this ED ECG: This shows diffuse ST depression (I, II, III, aVL, aVF, V3-V6) with reciprocal ST elevation in lead aVR.

STEMI 52

STEMI Coronary ACS Emergency Department 52

Dr. Smith's ECG Blog

APRIL 8, 2016

Here is his ED ECG: There is obvious infero-posterior STEMI. the associated loss is double, at 200-400 mEq.* [ Sterns RH, et al. Medics stated that he had not been taking his clopidogrel for 2 weeks. He appeared to be in shock. Bedside ultrasound showed no effusion and moderately decreased LV function, with B-lines of pulmonary edema.

STEMI 52

STEMI Plasma Defibrillator OR 52

Don't Forget the Bubbles

DECEMBER 5, 2023

Sex ed” sucks. They believe that Sex Ed programs are irrelevant to real-life experience and contain inadequate discussion of important issues, including consent or positive sexual relationships. Nizami T, Beaudoin F, Suner S, et al. Disease relapse should not automatically be assumed to mean failure of therapy. Crocker, B.C.S.,

Coronary 111

Coronary Epinephrine CPR Emergency Department 111