The Skeptics' Guide to EM

JANUARY 9, 2021

Date: January 5th, 2021 Reference: Grunau et al. JAMA 2020 Guest Skeptic: Mike Carter is a former paramedic and current PA practicing in pulmonary and critical care as well as an adjunct professor of emergency medical services […] The post SGEM#314: OHCA – Should you Take ‘em on the Run Baby if you Don’t get ROSC?

EMS 130

EMS Emergency Medical Services CPR Critical Care 130

EMDocs

SEPTEMBER 25, 2023

However, RSI has never been shown to reduce the risk of aspiration in the ED (13) or during emergent OR cases (14). While RSI should remain the gold standard in the vast majority of patients in the ED, FI presents an additional technique to mitigate anatomic or physiologic risk. To date, ketamine has been the agent of choice (12).

ED 91

ED Emergency Department ALS Paramedic 91

Pediatric EM Morsels

OCTOBER 27, 2023

Sinha 2012] It is useful in the prehospital setting , correlating well with actual weight and ED Broselow weight. link] Lubitz DS, Seidel JS, Chameides L, Luten RC, Zaritsky AL, Campbell FW. Accuracy of paramedic Broselow tape use in the prehospital setting. 2012.05.028 Silvagni D, Baggio L, Mazzi C, et al. and Seaver, M.

E-9-1-1 271

E-9-1-1 Emergency Medical Services Life Support ALS 271

The Skeptics' Guide to EM

AUGUST 14, 2021

Date: August 12th, 2021 Reference: Daya et al. Circulation 2020 Guest Skeptic: Missy Carter is a PA practicing in emergency medicine in the Seattle area and an adjunct faculty member with the Tacoma Community College paramedic program. Date: August 12th, 2021 Reference: Daya et al. Reference: Daya et al.

BLS 130

BLS CPR Paramedic ALS 130

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

The Skeptics' Guide to EM

OCTOBER 5, 2019

Date: September 25th, 2019 Reference: Bath PM et al. Guest Skeptic: Clay Odell is a Paramedic/RN for New London Hospital EMS in New Hampshire, USA which provides 9-1-1 coverage and Mobile Integrated Healthcare […] The post SGEM#269: Pre-Hospital Nitroglycerin for Acute Stroke Patients? The Lancet March 2019. The Lancet March 2019.

Ambulance 130

Ambulance Paramedic EMS ALS 130

The Skeptics' Guide to EM

JUNE 18, 2022

Date: June 18th, 2022 Reference: Crombie et al. Date: June 18th, 2022 Reference: Crombie et al. He is also now a fully fledged “sonologist” Casey currently splits his time between Broome, a small rural hospital in the remote Kimberley region of Western Australia, and a large tertiary ED in sunny Perth.

Plasma 100

Plasma Critical Care Paramedic ALS 100

The Skeptics' Guide to EM

JANUARY 8, 2022

Date: December 28th, 2021 Reference: Kulvatunyou et al. Date: December 28th, 2021 Reference: Kulvatunyou et al. Prior to earning his MD, he worked as a paramedic in the New York City 911 system. Reference: Kulvatunyou et al. J Trauma and Acute Care Surgery. November 2021. J Trauma and Acute Care Surgery.

ALS 130

ALS Emergency Department Paramedic OR 130

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 Paramedics managing a possible myocardial infarction patient were instructed to obtain rapidly an ECG prior to treatment with NTG.

Paramedic 52

Paramedic STEMI ACS Ambulance 52

ACEP Now

JANUARY 5, 2025

The PREOXI trial compared oxygen mask pre-oxygenation versus noninvasive positive-pressure ventilation (NIPPV) in patients requiring intubation in emergency departments (EDs) and intensive care units. 2 This was not an ED trial but was performed in stable patients on the inpatient wards. The obvious winner was NIPPV, whose 9.1

ALS 40

ALS E-9-1-1 ED Emergency Department 40

EMS 12-Lead

APRIL 14, 2022

Madden, Paramedic. An interesting comment provided by Paramedic Madden is that a few team members initially interpreted the T wave presentation as hyperkalemia, as opposed to occlusive hyperacuity. Let's revisit the deWinter occlusion provided by Paramedic Madden. link] [1] Zachary et al. Many thanks for sharing!

ACS 130

ACS Paramedic Coronary ALS 130

ACEP Now

NOVEMBER 8, 2024

The guidelines, updated most recently in 2019, note that endotracheal intubation is reserved for paramedics. Extraglottic devices, however, are in the scope of practice for both advanced emergency medical technicians (AEMTs) and paramedics, making the devices more widely applicable. Benger JR, Kirby K, Black S, et al.

E-9-1-1 40

E-9-1-1 Emergency Medical Services Emergency Medical Technician AEMT 40

EMS 12-Lead

MAY 8, 2022

David Didlake Firefighter / Paramedic Acute Care Nurse Practitioner @DidlakeDW Peer review provided by Dr. Steve Smith [link] @SmithECGBlog An adult female called 911 for chest discomfort and difficulty breathing. The following ECG was captured upon arrival at the receiving ED. The ED resulted an 8.7 The serum K returned 8.7,

STEMI 130

STEMI ED EMS Firefighter 130

EMS 12-Lead

APRIL 8, 2022

David Didlake Firefighter / Paramedic Acute Care Nurse Practitioner @DidlakeDW Peer review by Dr. Stephen Smith @smithECGblog I was reviewing ECG’s in our LifeNet database and happened upon this one without any knowledge of clinical circumstances. 1] Here is the admitting ED ECG after cancellation of Code STEMI. 1] Driver, B.

STEMI 130

STEMI ALS Coronary CAD 130

The Skeptics' Guide to EM

FEBRUARY 6, 2021

Their mission is to share knowledge with paramedics, nurses, medical student and also young doctors as they take their first steps in the field of emergency medicine. Reference: Ruberto et al. Case: A 32-year-old male patient presents to your emergency department (ED) with severe nausea, vomiting and abdominal pain.

ALS 100

ALS Emergency Department Paramedic OR 100

EMS 12-Lead

JUNE 20, 2022

David Didlake Firefighter / Paramedic Acute Care Nurse Practitioner @DidlakeDW Peer review provided by Dr. Steve Smith @SmithECGblog I was conducting QA/QI on two very recent cases and was struck by the uniqueness of both. Here is the final ECG just prior to ED transfer. But this ECG did not strike me as an LAD occlusion during QA/QI.

ACS 130

ACS Coronary STEMI CAD 130

EMS 12-Lead

JUNE 1, 2022

David Didlake Firefighter / Paramedic Acute Care Nurse Practitioner @DidlakeDW Peer review provided by Dr. Steve Smith [link] @SmithECGblog A 72 y/o Male experiences a syncopal episode while seated. Chou’s Electrocardiography in Clinical Practice (6th ed). He is due for a cardiologist appointment in five days. 2] Meyers, H.

Coronary 130

Coronary ALS ED ACS 130

EMS 12-Lead

AUGUST 22, 2022

Chou’s Electrocardiography in Clinical Practice (6th ed). References Chiale, P. Overdrive prolongation of refractoriness and fatigue in the early stages of human bundle branch disease. JACC, Vol 23, No 3; 724-32. Friedman, M., Transient unexpected improvement of AV conduction: What is the mechanism? Saini, A., Raymond-Paquin, A., 40, 1234-41.

E-9-1-1 130

E-9-1-1 Coronary ALS ICU 130

EMS 12-Lead

MAY 20, 2022

David Didlake Firefighter / Paramedic Acute Care Nurse Practitioner @DidlakeDW Peer review and commentary by Dr. Steve Smith [link] @SmithECGblog It is early-summer, approximately 1330 hours, no cloud cover overhead, and 86 degrees with high humidity. Below is the initial ED ECG. Manual of Cardiovascular Medicine (5th ed.).

Coronary 130

Coronary STEMI Firefighter ED 130

ACEP Now

OCTOBER 9, 2023

The doors slid open and above the rain I heard a woman yelling repeatedly in mixed English and Dari, “No, I do not consent,” while paramedics relayed their concern for a spinal injury after she fell down concrete steps. Kaufman EJ, Richmond TS, Wiebe DJ, et al. References American College of Surgeons Committee on Trauma.

Heart Attack 126

Heart Attack Life Support Emergency Department Ambulance 126

Dr. Smith's ECG Blog

OCTOBER 17, 2024

Written by Jesse McLaren Two patients in their 70s presented to the ED with chest pain and RBBB. Patient 1 : a 75 year old called paramedics with one day of left shoulder pain which migrated to the central chest, which was worse with deep breaths. The prehospital, ED computer, and final cardiology interpretation was STEMI negative.

STEMI 73

STEMI Paramedic Coronary ED 73

Broome Docs

DECEMBER 22, 2024

PARAMEDIC 3 randomized 6,000 (but they were supposed to get to 15,000) patients with out of hospital arrest from multiple EMS agencies in the UK to either an IO or IV to start. A Randomized Trial of Drug Route in Out-of-Hospital Cardiac Arrest. N Engl J Med. 2024 Oct 31:10.1056/NEJMoa2407780. doi: 10.1056/NEJMoa2407780. Epub ahead of print.

E-9-1-1 52

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

EMS 12-Lead

APRIL 2, 2022

David Didlake Firefighter / Paramedic Acute Care Nurse Practitioner @DidlakeDW Expert commentary provided by Dr. Ken Grauer CASE 1 An 82 y/o Male called 911 for sudden onset dizziness while at rest. Chou’s Electrocardiography in Clinical Practice, 6th ed. 4] Baranchuk, A, et al. 2] Surawicz, B. 3] Smith, S. 6] Goldberger, A.

ALS 130

ALS STEMI Coronary OR 130

ACEP Now

JUNE 6, 2023

When considering an optimized environment for compassionate patient communication, the chaotic emergency department (ED) probably gives some clinicians pause. Often, the outcome of an ED visit is not what the patient wants, but this skill prepares the patient for the reality. Visser M, et al. References Phillips KA, Ospina NS.

Emergency Department 98

Emergency Department ED OR Paramedic 98

Dr. Smith's ECG Blog

MAY 23, 2023

But the paramedic and the ED physician in this case did not subscribe to this idea. It is far too premature to say that paramedics and physicians should not be bothered to interpret ECGs labelled as "normal" or "otherwise normal" by the computer algorithm. Thus, this is obvious STEMI(+) OMI until proven otherwise.

STEMI 98

STEMI Coronary Paramedic OR 98

EMDocs

APRIL 22, 2024

4 In an emergency department (ED) presentation of cardiac arrest, the diagnosis of PE is challenging without the use of CT angiography. Case A 25-year-old-female presented to the ED in cardiac arrest. Paramedics reported that coworkers activated them after the patient was discovered unconscious with labored breathing.

ED 98

ED NARCAN ALS OR 98

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

Don't Forget the Bubbles

JUNE 30, 2023

All you know, back in ED, is that the ETA is 10 minutes, and there is a single stab wound to the chest. T – He’s got a single grey cannula in situ, and we’ve given him a 5 mg bolus of IiV morphine on the way in The primary survey Thanking the paramedic team, you ask the T&O SHO to proceed with a primary survey. Emerg Med J.

E-9-1-1 139

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

ACEP Now

DECEMBER 10, 2023

A middle-aged male with squamous cell carcinoma and extensive metastases is brought to the emergency department (ED) after being found unresponsive following a believed suicide attempt (SA) by methadone ingestion. Though paramedics administered naloxone, he remained somnolent. References Nowland R, Steeg S, Quinlivan L, et al.

Naloxone 52

Naloxone Life Support Paramedic ALS 52

Dr. Smith's ECG Blog

FEBRUARY 13, 2023

Written by Jesse McLaren Two 70 year olds had acute chest pain with nausea and shortness of breath, and called paramedics. But these ECGs were from the same patient: #1 on paramedic arrival and #2 thirty minutes later. Thankfully this patient’s second ECG met STEMI criteria, so paramedics brought them as a code STEMI.

STEMI 52

STEMI Paramedic Coronary ALS 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

Dr. Smith's ECG Blog

JULY 7, 2024

They arrived in the ED 30 minutes later to meet the cardiology team, where an ECG was repeated: Again no STEMI criteria, and there has been improvement in the deWinter and swirl pattern. 2022 — and — Kontos et al; 2022 ACC Expert Consensus — JACC 80(20):1925-1960, 2022 ).

STEMI 66

STEMI Coronary ALS OR 66

Dr. Smith's ECG Blog

OCTOBER 3, 2018

This was shown to me by a very astute Hennepin paramedic. Although this comes from a Hennepin paramedic, the patient was not brought to Hennepin County Medical Center. It is important for cardiologists to realize that a paramedic may see something they do not. For some reason unknown to me, the interventionalist was in the ED.

Coronary 52

Coronary STEMI Paramedic ALS 52

The Overrun

DECEMBER 7, 2019

Ed Bauter is a paramedic and second year medical student. 1] Vigal, et al. Prehospital Emergency Care May-June 2019 “Death by Suicide- The EMS profession compared to the general public” [2] Rose, et al. She wasn’t the first, and she won’t be the last. And that pisses me off.

EMS 52

EMS Firefighter ALS Paramedic 52

Dr. Smith's ECG Blog

JUNE 11, 2021

The paramedics found the patient with ROSC and a GCS 7, and an ECG showing LBBB with possible lateral ST elevation. The patient was brought to the ED as a possible Code STEMI and was seen directly by cardiology. Below is the first ED ECG, labeled LBBB by the machine. Vitals were HR 58 BP 167/70 R20 sat 96%.

EMR 52

EMR STEMI CPR ED 52

The Overrun

NOVEMBER 28, 2022

Whether it be at a college party or in the nursing home at 3 AM, managing an acute psychosis patient is something EMTs and Paramedics encounter with frequency during their tenure. Sources Perälä J, Suvisaari J, Saarni SI, et al. 2 Olfson M, Lewis-Fernández R, Weissman MM, et al. Arch Gen Psychiatry. 2007;64(1):19–28.

EMT 52

EMT EMT Emergency Department Paramedic 52

Dr. Smith's ECG Blog

NOVEMBER 19, 2016

Clinical Course The paramedic activated a “Code STEMI” alert and transported the patient nearly 50 miles to the closest tertiary medical center. The patient was brought directly to the cardiac catheterization lab for PCI, bypassing the ED. 2 The astute paramedic recognized this possibility and announced a CODE STEMI.

Coronary 40

Coronary ACS ALS STEMI 40