Dr. Smith's ECG Blog

OCTOBER 24, 2018

Therefore, this does not meet the definition of myocardial infarction ( 4th Universal Definition of MI ), which requires at least one troponin above the 99% reference range. You can see the deficiency of the definition of MI. Thelin et al. Mokhtari et al. This is subtle — but it is definitely present.

E-9-1-1 52

E-9-1-1 STEMI ACS Coronary 52

The Skeptics' Guide to EM

OCTOBER 20, 2018

[display_podcast] Date: October 17th , 2018 Reference #1: Aycock, Westafer et al. Ann Emerg Med 2018 (CRD42017056195) Reference #2: Weisbord SD, Gallagher M, Jneid H, et al; PRESERVE Trial Group. display_podcast] Date: October 17th , 2018 Reference #1: Aycock, Westafer et al. Reference: Aycock, Westafer et al.

Coronary 171

Coronary Emergency Department ALS OR 171

ALiEM

SEPTEMBER 29, 2023

In cases where the nature of the missile is known, plain films or POCUS may be a reasonable first step, but CT imaging would be definitive. References Goodwin RB, Beery PR 2nd, Dorbish RJ, et al. Penetrating wounds can be deceptively innocuous, and a high index of suspicion is required. The Journal of Trauma.

ALS 177

ALS OR 177

Pediatric EM Morsels

APRIL 7, 2023

References: Al Kasab S, Lynn MJ, Turan TN, Derdeyn CP, Fiorella D, Lane BF, Janis LS, Chimowitz MI; SAMMPRIS Investigators. No fibrinolytic here – transfusion to help increase the percentage of adult vs sickle cell hemoglobin is treatment of choice for ischemic infarcts!

ALS 130

ALS OR Critical Care EMS 130

The Skeptics' Guide to EM

MAY 6, 2023

Date: April 25, 2023 Reference: Walsh et al. Date: April 25, 2023 Reference: Walsh et al. At that time, we recognized there was no universally accepted definition of excited delirium. WJEM 2023 There were five key points raised in the article: Continuing lack of a clear definition for excited delirium

Emergency Medical Services 101

Emergency Medical Services Paramedic ALS EMS 101

The Skeptics' Guide to EM

JANUARY 1, 2022

Reference: Grotta JC et al. Reference: Grotta JC et al. The primary outcomes reported better neurologic outcome at seven days but not at one day post treatment by a MSU compared to conventional care ( Fatima et al Int J Stroke 2020 ). Reference: Grotta JC et al. Howie also has a Master of Public Health.

Emergency Medical Services 130

Emergency Medical Services Firefighter Paramedic ALS 130

REBEL EM

APRIL 29, 2024

A study by Lee et al ( 7) compared femoral CVC placement to IO and demonstrated a first-pass success pass rate with IO of 90.3% References: 1 Astasio-Picado Á et al. Ong MEH, Chan YH, Oh JJ, et al. Iserson KV et al. PMID: 8913236 7 Lee PM et al. 9 Zhang W et al. compared to only 37.5% in the CVC group.

ALS 102

ALS Epinephrine Critical Care Emergency Department 102

Don't Forget the Bubbles

OCTOBER 4, 2023

Formentin C, et al. Jørgensen RM, et al. Harris J, et al. Bhatia S, et al. Vivarelli M, et al. Morello W, et al. McGowan EC, et al. Hirata K, et al. Shaikh N, et al. Determining the Best Definition for a Positive Urine Culture in Young Children. Wald ER, et al. 2023 Sep 13.

E-9-1-1 111

E-9-1-1 ALS Emergency Department OR 111

REBEL EM

FEBRUARY 7, 2024

In: Marx, J et al, ed. In: Marx, J et al, ed. Chorioamnionitis is a bacterial infection of fetal amnion and chorion membranes. Labor and Delivery and Their Complications. Rosen’s Emergency Medicine. Philadelphia, PA: Elsevier Saunders; 2014:2331-2350. Gorgas, D. “Infections related to pregnancy.” 8 th ed.

ED 96

ED ALS OR EMS 96

Pediatric EM Morsels

SEPTEMBER 22, 2023

Definition A series of hemodynamic changes related to autonomic denervation and loss of sympathetic tone. Tenenbein M, Macias CG, Sharieff GQ, et al, eds. Tenenbein M, Macias CG, Sharieff GQ, et al, eds. Main symptoms include hypotension and bradycardia. They may even need atropine and/or pacing for persistent bradycardia.

E-9-1-1 300

E-9-1-1 Epinephrine ALS EMS 300

Broome Docs

FEBRUARY 22, 2024

PMID: 36946338 Bottom line: This is a well done RCT that demonstrates pretty convincingly that you should not bother trying to but fingernails back on after nail bed repair (and my guess is you definitely shouldn’t be removing them either). Carson JL, Brooks MM, Hébert PC, et al; MINT Investigators. N Engl J Med. 2023 Nov 11.

Emergency Department 103

Emergency Department ALS OR ED 103

ACEP Now

MARCH 14, 2024

Tracheo-innominate fistula (TIF) is an unusual and frequently lethal complication of such definitive airway placement. 15 Definitive Treatment Definitive treatment of TIF has traditionally involved median sternotomy and ligation of the innominate artery. Scalise P, Prunk SR, Healy D, et al. Mun JH, Jun PS, Sim Y-J, et al.

E-9-1-1 52

E-9-1-1 ALS Operating Room OR 52

The Skeptics' Guide to EM

MAY 12, 2018

[display_podcast] Date: May 12th, 2018 Reference: Gonin P et al. display_podcast] Date: May 12th, 2018 Reference: Gonin P et al. Over 150 years since it was first described, there is still no standardized definition of ExDS and diagnostic criteria have not been universally recognized. Reference: Gonin P et al.

Emergency Department 130

Emergency Department ALS OR 130

The Skeptics' Guide to EM

MARCH 5, 2022

Date: February 24th, 2022 Reference: Parish et al. Date: February 24th, 2022 Reference: Parish et al. Tricoci et al. The definitions used for each level of evidence are as follows: An update was published by Fanaroff et al in JAMA 2019. JAMA Feb 2009 looked at the ACC/AHA guidelines from 1984 to 2008.

Epinephrine 100

Epinephrine ALS OR 100

This Podcast Will Kill You

MAY 7, 2024

Dietary supplements: a definition that is black, white, and gray. Djaoudene, Ouarda, et al. Herasimenka, Aliaksandr, et al. History Biology Sneader, Walter. Drug discovery: a history. John Wiley & Sons, 2005. American Journal of Law & Medicine , 31 (2-3), pp.341-348. Arora, Ishaan, Shecoya White, and Rahel Mathews.

ALS 98

ALS OR 98

REBEL EM

JANUARY 18, 2024

Paper: Varney J et al. Any of the outcomes could be statistically significant by chance alone as mortality was not the primary outcome in all the included studies Too few studies included in the meta-analysis (4 trials total) to draw any definitive conclusions. References: Varney J et al. Health Sci Rep 2022.

ICU 126

ICU ALS EMS 126

NAEMSP

MARCH 5, 2024

Article Summary by Sarah Fabiano, MD, FACEP, FAAEM Lyng JW, Braithwaite S, Abraham H, et al. There has been literature to support the use of air in trauma-both because of the time to definitive care but also the critical care that can be started at the scene. Prehosp Emerg Care 2021 Nov-Dec;25(6):854-73.

Critical Care 52

Critical Care Medical Transportation CPR EMS 52

REBEL EM

AUGUST 30, 2023

REBEL Core Cast 107.0 – Vertebral Osteomyelitis Click here for Direct Download of the Podcast Definition Inflammation of the vertebrae due to a pyogenic, fungal or mycobacterial organism. Graphics Image 1: [link] Image 2: [link] References Berbari EF, Kanj SS, et al. PMID: 26316526 Boody B, et al. J Antimicrob Chemother.

E-9-1-1 94

E-9-1-1 ALS ED OR 94

The Skeptics' Guide to EM

NOVEMBER 1, 2022

Date: October 27th, 2022 Reference: Hayashi et al. Date: October 27th, 2022 Reference: Hayashi et al. There have been a few randomized control trials (RCTs) of peripheral nerve blocks for shoulder dislocation, but without definitive results (Raeyat Doost 2017; Blaivas 2011).

ALS 152

ALS Emergency Department OR ED 152

Dr. Smith's ECG Blog

JANUARY 27, 2024

Deutch et al. Over the years — various definitions have been proposed for what should constitute a " significant " Q wave , based on width and/or depth of the Q wave. Validity of computer-interpreted ‘normal’ or ‘otherwise normal’ ECG in emergency department triage pateints. West J Emerg Med 2024).

STEMI 104

STEMI Coronary ACS ED 104

ACEP Now

MAY 9, 2024

Taking a different approach than the authors of the AHRQ report, Auerbach et al used a “look back” approach to perform both qualitative and quantitative evaluations of the types and frequencies of errors occurring in hospital settings. References Newman-Toker DE, Peterson SM, Badihian S, et al. Auerbach AD, Lee TM, Hubbard CC, et al.

Emergency Department 52

Emergency Department ICU ALS ACS 52

REBEL EM

JUNE 22, 2023

However, the medical community is only just starting to understand long-COVID (WHO Definition: the continuation or development of new symptoms 3 months after the initial SARS-CoV-2 infection, with these symptoms lasting for at least 2 months with no other explanation). Article: Bramante CT et al. References: Bramante CT et al.

ALS 144

ALS OR EMS ED 144

ALiEM

OCTOBER 30, 2023

Let’s start with the obligatory definition of coaching. PMID 18945997 Elster MJ, O’Sullivan PS, Muller-Juge V, et al. PMID 29686766 Jordan J, Coates WC, Clarke S, et al. PMID 29760865 Bentley S, Stapleton SN, Moschella PC, et al. PMID 32072117 Wolff M, Deiorio NM, Juve AM, et al. Perspect Med Educ.

E-9-1-1 161

E-9-1-1 ALS OR 161

Dr. Smith's ECG Blog

AUGUST 9, 2024

Although recognition of OMI was not affected by administration of morphine in this case, use caution with analgesia in ongoing ACS without a definitive plan for angiography. Bigger et al. Sadowski ZP, Alexander JH, Skrabucha B, et al. Bigger JR Jr, Dresdale RJ, Heissenbuttel RH, et al. In other words, it is a safe rhythm.

STEMI 88

STEMI Coronary Heart Attack ACS 88

FOAMcast

OCTOBER 17, 2023

Apple Podcasts , Spotify , Listen Here Resuscitative endovascular balloon occlusion of the aorta (REBOA) is a minimally invasive way of providing resuscitative aortic occlusion in severe hemorrhage to gain temporary hemorrhage control as a bridge to definitive procedures. ” As a result, Jansen et al. 2023 JAMA.

ACS 52

ACS ALS OR 52

REBEL EM

JUNE 26, 2024

Definition: A serum potassium level > 5.5 PMID: 20855477 Wrenn K et al. PMID: 1952310 Aslam S et al. PMID: 12198216 Montague BT et al. PMID: 18235147 Mattu A et al. PMID: 18936701 Moussavi K et al. rhabdomyolysis -> hydration) Remove inciting factors (i.e. CMAJ 2010; 182(15): 1631-5.

ALS 55

ALS OR EMS 55

The Skeptics' Guide to EM

APRIL 6, 2019

Date: April 5th, 2019 Reference: Connolly et al. Date: April 5th, 2019 Reference: Connolly et al. We covered the interim analysis of 90 patients included in a prospective cohort study by Pollack et al NEJM 2015 on SGEM#139. Full Study Report of Andexanet Alfa for Bleeding Associated with Factor Xa Inhibitors.

Frozen Plasma 130

Frozen Plasma Plasma ALS EMS 130

The Skeptics' Guide to EM

JANUARY 30, 2021

Reference: George et al. Reference: George et al. This was based on two definitions. Steve is currently an Assistant Professor in the Department of Family Medicine at Western University (London, Ontario) working at the Fowler Clinic and the Roth McFarlane Hand and Upper Limb Centre. J Bone Joint Surg Am. J Bone Joint Surg Am.

OR 130

OR ALS 130

Broome Docs

JUNE 20, 2023

Here we go… Liu S, Yao C, Xie J, et al. Bramante CT, Buse JB, Liebovitz DM, et al. PMID: 35723686 Pacheco LD, Clifton RG, Saade GR, et al; Eunice Kennedy Shriver National Institute of Child Health and Human Development Maternal–Fetal Medicine Units Network. JAMA Intern Med. 2023 May 1:e230780. doi: 10.1001/jamainternmed.2023.0780.

Emergency Department 132

Emergency Department ALS 132

Don't Forget the Bubbles

AUGUST 23, 2023

Definitive emotional support is critical to our emotional and psychological well-being. Kapoor et al. This gives rise to feelings of failure alongside the feelings of grief. Psychological harm occurs. To limit the psychological harm, perhaps we should implement THE PAUSE. Southern Medical Journal. 112 (9),pp. Newell, J. &

Emergency Department 98

Emergency Department ICU ALS Critical Care 98

The Skeptics' Guide to EM

FEBRUARY 15, 2020

Date: February 11th, 2020 Reference: Yeh et al. Date: February 11th, 2020 Reference: Yeh et al. Only then would we have definitive evidence that a parachute was effective in preventing death and major trauma related to gravitational challenges. Reference: Yeh et al. Guest Skeptic: Marcus Prescott is a nurse in Norway.

ALS 130

ALS Emergency Department OR 130

The Skeptics' Guide to EM

JUNE 27, 2020

I used the original definition of EBM given by Dr. David Sackett: “The conscientious, explicit and judicious use of current best evidence in making decisions about the care of individual patients.” ( Sackett et al BMJ 1996 ) There are three pillars to EBM than can be represented in a Venn diagram.

ALS 130

ALS OR 130

The Skeptics' Guide to EM

MARCH 2, 2019

Date: February 26th, 2019 Reference: Benger et al. Date: February 26th, 2019 Reference: Benger et al. They had a difficult time getting a definitive airway pre-hospital. Reference: Benger et al, Effect of a Strategy of a Supraglottic Airway Device
vs. Effect of a Strategy of a Supraglottic Airway Device
vs.

CPR 130

CPR Firefighter Defibrillator Epinephrine 130

Core EM

JANUARY 25, 2024

Written By: Kaitlynn Tracy, MD Edited By: Sean Schnarr, MD and Gregg Chesney, MD Definition/Background: Burns are classified as being major, moderate, or minor in severity. Tintinalli, et al. 4 Survival rate for all burn injuries is around 97%, which is a notable increase from 75% in the 1960’s. Wiktor, Arek, and David Richards.

ED 246

ED E-9-1-1 OR First Aid 246

Dr. Smith's ECG Blog

SEPTEMBER 11, 2024

Acute MI per se usually does not depress cardiac function and blood pressure enough to cause syncope ( Mostafa et al — J Com Hosp Intern Med Perspect 13(4):9-12, 2023 - ). The initial ECG in today's case was recognized as definitely abnormal — but the question arose as to whether this ECG indicated old infarction vs a new acute event.

EMS 107

EMS CPR ED Coronary 107

EMS 12-Lead

AUGUST 22, 2022

They are not premature, by definition. The blue arrows show RBBB morphology, and it’s tempting to deploy a compulsory diagnosis of PVC’s, but remember: these wide QRS complexes arrive subsequent to a regularly timed P wave. The green arrows, however, do show premature complexes. References Chiale, P. JACC, Vol 23, No 3; 724-32. Friedman, M.,

E-9-1-1 130

E-9-1-1 Coronary ALS ICU 130

EMDocs

AUGUST 12, 2023

Çalışkan Uçkun A, Yurdakul FG, Ergani HM, et al. link] Alkandari A F, Alawadhi A, Alawadhi F A, et al. doi:10.1055/s-0032-1327007 Zhao W, Wang G, Chen B, et al. 0000000000017823 Rosskopf AB, Martinoli C, Sconfienza LM, et al. Stevens KA, Caruso JC, Fallahi AKM, Patiño JM. Flexor Tendon Lacerations. In: StatPearls.

EMS 69

EMS ALS Emergency Department OR 69