Dr. Smith's ECG Blog

DECEMBER 27, 2023

Written by Willy Frick A man in his 50s with a history of hypertension, dyslipidemia, type 2 diabetes mellitus, and prior inferior OMI status post DES to his proximal RCA 3 years prior presented to the emergency department at around 3 AM complaining of chest pain onset around 9 PM the evening prior. ECG 1 What do you think? Grines, C.

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Dr. Smith's ECG Blog

JULY 22, 2023

A prior ECG from 1 month ago was available: The presentation ECG was interpreted as STEMI and the patient was transferred emergently to the nearest PCI center. Patients that develop a Type 1 pattern without any precipitating or provoking factors have a risk of SCD of 0.5-0.8% per year incidence of SCD in this cohort [1].

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EMDocs

AUGUST 22, 2024

1 However, we recognize that many patients prefer to speak a language other than English regardless of their English proficiency, and this does not indicate a deficiency. 9 Less likely to be satisfied with their care and have a lower understanding of their discharge instructions. 11 Unlikely to receive language assistance.

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Pediatric EM Morsels

AUGUST 18, 2023

Myth #1: Musculoskeletal Adverse Events (MAE) This concern is likely the most common reason fluoroquinolones are rarely used in children. Which is a risk of 1 event for 62.5 None of the patients were documented to have joint disease at follow up. PMID: 27940800 Hersch AL, Gerber JS, Hicks LA, Pavia AT. Pediatrics.

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REBEL EM

JULY 3, 2023

Article: Rossi N et al. Pregnant or incarcerated patients Documentation for systolic BP is incomplete Intervention: Administration of IV calcium within 60 min prior to or 30 min after IV diltiazem administration in patients with AF/AFL with RVR. The study was dependent on EMR documentation which is prone to error.

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Don't Forget the Bubbles

DECEMBER 16, 2024

Coverage of the 6-in-1 vaccine measured at 12 months of age in England for Q4 2023 to 2024 Source: ONS under the Open Government License v3.0 Young infants and immunosuppressed individuals are particularly at risk of severe disease, resulting in significant morbidity and associated mortality rates of 1-3 per 1,000 cases.

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Don't Forget the Bubbles

MAY 6, 2024

Article 1: Positive urine cultures without pyuria Wang ME, Jones VG, Kane M, et al. Clinical Course of Children 1 to 24 Months Old With Positive Urine Cultures Without Pyuria. 2024;24(1):111-118. of patients with follow-up documentation, 70.8% (95% CI 62.9–77.9) Giannoni, E., Acad Pediatr. Of the 74.9%

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REBEL EM

OCTOBER 5, 2023

1-6 We now have the Community-Acquired Pneumonia: Evaluation of Corticosteroids (CAPE COD) Trial. Paper: Dequin P, Meziani F, Quenot J, et al. Patients admitted to the ICU with severe community-acquired pneumonia were randomized in a 1:1 ratio to receive hydrocortisone or a placebo. N Engl J Med. 2023;388(21):1931-1941.

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Don't Forget the Bubbles

FEBRUARY 26, 2024

In 2015, Silva et al. 2007 Jan 1;25(1):6-9. uk/document-library/clinical-information/asthma/btssign-asthma-guideline-2019. Add in PEFR <33% and SpO2 <92% Management of acute asthma* * as per BTS guidelines Acute asthma is managed in a stepwise fashion using the following guidelines. Frontiers in Pediatrics.

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Dr. Smith's ECG Blog

FEBRUARY 28, 2020

4 important features that indicate acute right hear strain: 1. Kosuge et al. In this study, (quote) "negative T waves in leads III and V 1 were observed in only 1% of patients with ACS compared with 88% of patients with APE (p less than 0.001). Witting et al. Finally, Stein et al. Tachycardia (or nearly) 2.

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Dr. Smith's ECG Blog

JANUARY 30, 2019

The pattern of STE and STD reminded us of Brugada Type 1 morphology. Smith comment: 1) Brugada ECG may have ST shifts in limb leads as well as precordial leads. Patients that develop a Type 1 pattern without any precipitating or provoking factors have a risk of SCD of 0.5-0.8% per year incidence of SCD in this cohort [1].

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NAEMSP

JANUARY 5, 2023

1] The Adult Cardiac Arrest ACLS algorithm currently includes epinephrine and either amiodarone or lidocaine as recommended pharmacologic therapies. al answered this question with a prospective observational study which showed a significantly shorter time interval to obtain tibial IO access (4.6 1] Table from Hamam et al.

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REBEL EM

SEPTEMBER 26, 2022

Article: Kumar M et al. 2020;71(1):235-246. Plt 37×10^9/L and 40×10^9/L, SOC and TEG, respectively) All patients enrolled had an upper endoscopy and verified the source of bleeding. Hepatology. Significant coagulopathy: INR > 1.8 Significant coagulopathy: INR > 1.8

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Dr. Smith's ECG Blog

JANUARY 5, 2020

There are 5 other rhythms that are irregularly irregular , though atrial fibrillation is by far the most common: 1. See below how this has been documented. However, incorrect automated and physician overread interpretations are common and have been shown to adversely affect patient management [ 1 ]. Taggar et al.

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ACEP Now

FEBRUARY 11, 2024

Gently inject 1 to 2 cc of anesthetic to hydrodissect the clavipectoral fascia from the clavicle. 8 For all ultrasound-guided nerve blocks, we recommend placing documentation both in the EHR and as a small skin marking with a surgical pen on the patient. References Postacchini F, Gumina S, De Santis P, et al. 2002;11:452-456.

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EMDocs

JANUARY 11, 2024

The neurologic section was divided into (1) brain oxygenation, perfusion, edema, and intracranial pressure (ICP); (2) seizures and the ictal-interictal continuum (IIC); and (3) sedation and analgesia. Reference: Hirsch KG, Abella BS, Amorim E, et al; American Heart Association, Neurocritical Care Society. 2023 Dec 1.

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Dr. Smith's ECG Blog

NOVEMBER 28, 2022

Right atrial diastolic collapse is the earliest sign, but the patient needs to have right atrial collapse for at least 1/3 of the cardiac cycle which can be difficult to identify with ultrasound. Beck’s triad only happens all 3 together in approximately 1/3rd of patients. 2013 Sep;26(9):965-1012.e15. J Am Soc Echocardiogr.

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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. 9=11 70% monomicrobial, 25% poly-microbial, 5% culture-negative. 9=11 70% monomicrobial, 25% poly-microbial, 5% culture-negative. 8 Perform and document distal neurovascular exam.

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EMDocs

FEBRUARY 12, 2024

Introduction Arterial blood gas (ABG) or venous blood gas (VBG) testing is used to assess the pH and systemic carbon dioxide tension in patients, and, therefore, provide a more complete picture of their acid-base status than an isolated basic metabolic panel (BMP) (1). However, ABGs have many drawbacks compared to VBGs.

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EMDocs

JULY 3, 2023

This neurological evaluation should include assessment and documentation of the GCS, the presence of any neurologic deficits, and an NIHSS. 9 Delayed NCHCT is less sensitive due to decreased visibility of blood collection secondary to red blood cell (RBC) degradation. 2022 Jan;39(1-2):35-48. Avest E, Taylor S, Wilson M, et al.

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AAEM RSA

DECEMBER 3, 2020

Introduction: While cases of genital gangrene were documented as early as 980 CE, the condition we know today as FG was coined in the 1880’s by French venerologist, Jean Alfred Fournier. Fournier gangrene: an histori9]al reappraisal. 2018;48(9):1157-1160. 2020;26(1):8-17. Sugihara T, Yasunaga H, Horiguchi H, et al.

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ACEP Now

OCTOBER 9, 2023

Physicians should document the interpreter’s name and identification number if available in the patient’s chart. 9 Being bilingual is often not enough to be a medical interpreter, which requires precision, experience, and knowledge of medical jargon, as well as culturally specific idioms and phrases. 2022;105(1):62-73.

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Dr. Smith's ECG Blog

APRIL 8, 2015

Also consider non-hemorrhagic volume depletion, dehydration : orthostatic vitals may uncover this [see Mendu et al. (3)]. Cardiac Syncope ("True Syncope") Independent Predictors of Adverse Outcomes condensed from multiple studies 1. Palpitations preceding syncope (highest value on EGSYS score) 9. S yncope while supine (EGSYS) 8.

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AAEM RSA

SEPTEMBER 17, 2020

Thiamine also plays a role in key metabolic processes, including cellular energy production and generation of cellular antioxidants, and thiamine deficiency has been well-documented in sepsis, with observational studies indicating a signal for improved outcomes with supplementation. Marik P, Khangoora V, Rivera R, et al. Critical Care.

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REBEL EM

NOVEMBER 11, 2024

Article: Chanderraj R, Admon AJ, He Y, et al. What They Did: Investigators performed a retrospective cohort study in the Emergency Department at the University of Michigan between July 1, 2014 through December 31, 2018. Comorbidity Index : Higher in the cefepime group (median 2 vs. 1). In 2021, Buckley et. JAMA Intern Med.

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Don't Forget the Bubbles

JULY 5, 2023

Figure 1: Clinical manifestations and long-term consequences of sickle cell disease Training and education on sickle cell disease: Training and education are crucial to improve morbidity and mortality. Investigations : Bloods show Hb of 8 g/L, White cell count 13x 10 9 /L, Platelets 570 x10 9 /L, CRP 35mg/L.

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Dr. Smith's ECG Blog

JANUARY 13, 2025

When I saw this (presented at a conference), I immediately thought it looked like Thype 1 Brugada phenocopy (in other words, Type 1 Brugada ECG pattern ). If the QRS is prolonged, then the differential includes: 1. Criteria for Type 1 Morphology: 1. A flat ST segment will have a Corrado index greater than 1.

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This Podcast Will Kill You

DECEMBER 3, 2024

Andriantsoanirina, Valérie, et al. ” Parasites & Vectors 9 (2016): 1-8. ” Parasites & vectors 10 (2017): 1-22. The Journal of the American Board of Family Medicine , 30 (1), pp.78-84. Journal of the European Academy of Dermatology and Venereology , 37 (9), pp.1749-1757. Lane, John E.

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Don't Forget the Bubbles

AUGUST 10, 2023

Descriptive Terms When describing injuries of the hand for documentation or referral purposes it is important to know the terminology that is widely in use in order to convey an accurate description to others. Hand dominance, mechanism of injury and vascular, neurological, and musculoskeletal status should all be evaluated and documented.

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ACEP Now

FEBRUARY 19, 2025

AI started to make its mark in the ED by maximizing the efficiency of certain tasks like patient triage, clinical presentation diagnosis, mortality prediction, clinical decision making, and operational workflow management (see Figure 1). Tsai CH, Eghdam A, Davoody N, et al. Kirubarajan A, Taher A, Khan S, et al. Life (Basel).

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Core EM

JANUARY 16, 2025

Success at intubation likely takes more time and practice than other procedures, as shown in recent research on ED residents and their success rate at intubating, measured as a function of their total number of intubations (See Figure 1). This document will focus on the anatomical considerations and aspiration risk.

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ACEP Now

OCTOBER 29, 2024

EMS found the patient pulseless and apneic, with an initial rhythm showing ventricular fibrillation (see figure 1). Figure 1: The EMS rhythm strip. A repeat ECG (see figure 3) was performed utilizing the technique described by Sangwatanaroj et al., Type 3 is indicated by J point and ST elevation < 1 mm.

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Don't Forget the Bubbles

NOVEMBER 5, 2023

Gorga SM, et al. Opel DJ, et al. Vial T, et al. Harris J, et al. Chiriac A, et al. Clarke P, et al. Wang T, et al. Prasad V, et al. Jensen ET, et al. Xylitol for the prevention of acute otitis media episodes in children aged 1-5 years: a randomised controlled trial. 2023 Oct 20.

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EMDocs

NOVEMBER 6, 2024

What are important clinical features differentiating strychnine and tetanus toxicity to aid with diagnosis? How does the clinical management of strychnine and tetanus differ? Site of action of strychnine and tetanus. red X = target of strychnine = target of tetanus Adapted from: Stephan J. Neurotransmitter. 2015;2:10-14800/nt. doi:10.14800/nt.491

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EMDocs

JANUARY 6, 2025

ED Evaluation Transport to the ED from the refugee reception center takes 1 hour. g/dL, thrombocytopenia of 96 10 9 /L, prothrombin time (PT) of 16.1 1 By the end of 2023, 117.3 million people had been forcibly displaced, representing 1 in 69 individuals or 1.5% seconds (normal 30-40 seconds), creatinine of 3.11

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