Ambulance, E-9-1-1 and ED - Paramedicine Now

Concerning EKG with a Non-obstructive angiogram. What happened?

Dr. Smith's ECG Blog

DECEMBER 19, 2023

[link] A 62 year old man with a history of hypertension, type 2 diabetes mellitus, and carotid artery stenosis called 911 at 9:30 in the morning with complaint of chest pain. The ambulance report says "BP continued to drop during transport and pt remained cold and clammy." But there are other KEY changes!

E-9-1-1

E-9-1-1 Coronary ACS BLS

emDOCs Podcast – Episode 90: Hypokalemic Periodic Paralysis

EMDocs

NOVEMBER 21, 2023

Could not ambulate. In ED, repeat potassium level was 2.6 Epidemiology: Prevalence of hypoPP is approximately 1 per 100,000. 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.

E-9-1-1

E-9-1-1 ALS ED OR

What does the angiogram show? The Echo? The CT coronary angiogram? How do you explain this?

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. IMPRESSION: 1. This originally radiated into her left arm. Over some time and the pain moved into her other arm as well as her jaw. The Queen no longer thinks it is OMI.

Coronary

Coronary E-9-1-1 STEMI ACS

A man in his 70s with chest pain during a bike ride

Dr. Smith's ECG Blog

SEPTEMBER 30, 2019

It was a constant ache on the left side of his chest that forced him to stop cycling and call for an ambulance. For clarity — I’ve put these 2 tracings together in Figure-1. Figure-1: The initial ED ECG ( = E CG # 1) — with comparison to the patient’s baseline ECG done 4 years earlier ( = E CG # 3).

E-9-1-1

E-9-1-1 Coronary STEMI Emergency Department

A 58 year old with Weakness and more than 4 mm ST Elevation in V3

Dr. Smith's ECG Blog

AUGUST 9, 2018

Ambulated to ambulance for eval. It's important and useful to note that 1) Over 90% of healthy young men have up to 3mm ST elevation in one or more precordial leads normally (Atlas of Electrocardiography by K. My Comment , by K EN G RAUER, MD ( 8/9/2018 ): == Our thanks to Lou B for this insightful case.

E-9-1-1

E-9-1-1 STEMI Coronary Ambulance

EM@3AM: Total Hip Arthroplasty Complications

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. 9=11 70% monomicrobial, 25% poly-microbial, 5% culture-negative. 2020 Sep 30;5(9):558-567.

EMS

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

Sepsis Updates Relevant to the Emergency Physician

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. These include C-reactive protein, procalcitonin, interleukin-6, CD64, presepsin, and sTREM-1.

E-9-1-1

E-9-1-1 ALS Emergency Department Plasma

Penetrating chest trauma

Don't Forget the Bubbles

JUNE 30, 2023

He has already climbed Ben Nevis in Scotland, visited the Gobi desert (possibly from the comfort of his parents 4 x 4, but who’s judging) and has his bronze D of E nailed. All you know, back in ED, is that the ETA is 10 minutes, and there is a single stab wound to the chest. A PEM Adventure Ranulf is a 14-year-old explorer.

E-9-1-1

E-9-1-1 FFP Plasma Emergency Department

Awake, and Paralysed: A Never Event

Don't Forget the Bubbles

NOVEMBER 29, 2023

A 12-year-old male is being transported by ambulance after a road traffic accident. Intensive Care Research , 1 (3-4), pp.60-64. A 2012 study on paediatric patients showed that approximately 42% were intubated without medications, and 2% were intubated with paralysis only in the ED. Epub 2014 Sep 9. 2013 Jan;31(1):222-6.

E-9-1-1

E-9-1-1 Emergency Department ED CPR

Another deadly triage ECG missed, and the waiting patient leaves before being seen. What is this nearly pathognomonic ECG?

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. Pain improved to 1/10 after EMS administers 324 mg aspirin and the following EKG is obtained at triage. What do you think?

E-9-1-1

E-9-1-1 ACS Emergency Department Coronary

Subarachnoid hemorrhage: ED presentation, evaluation, and management

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

ED E-9-1-1 ALS OR

How should we assess febrile infants? Results from the FIDO study

Don't Forget the Bubbles

NOVEMBER 27, 2024

Umana E, Mills C Norman-Bruce H, Mitchell H, McFetridge L, Lynn F, McKeeman G, Foster S, Barrett MJ, Roland D, Lyttle MD, Watson C, Waterfield T, on behalf of Paediatric Emergency Research in the UK and Ireland (PERUKI), Lancet eClinical, 2024 Who were the patients? An additional 1 ml of blood was taken for PCT from some infants.

E-9-1-1

E-9-1-1 Emergency Department Ambulance ED

Major Trauma – Injuries by Assault

Don't Forget the Bubbles

FEBRUARY 5, 2025

Ali, a 12-year-old male, is pre-alerted by ambulance to ED. The pre-alert from the ambulance states his GCS is 12 (E3V4M5), moving all 4 limbs with an obvious large haematoma to the back of his head. How would you prepare for the patient’s arrival to ED? Do I have emergency blood available in the ED?

E-9-1-1

E-9-1-1 CPR Ambulance ED

Febrile Seizures

Don't Forget the Bubbles

AUGUST 13, 2023

Febrile seizure is one of the common presentations in the paediatric ED, causing significant parental anxiety (especially following the first episode). Some common misconceptions such as use of antipyretics to prevent febrile convulsions or it leading to epilepsy in future can be prevented by good parental education during ED visit.

E-9-1-1

E-9-1-1 ED OR First Aid

Paramedicine Now

Concerning EKG with a Non-obstructive angiogram. What happened?

emDOCs Podcast – Episode 90: Hypokalemic Periodic Paralysis

Trending Sources

What does the angiogram show? The Echo? The CT coronary angiogram? How do you explain this?

A man in his 70s with chest pain during a bike ride

A 58 year old with Weakness and more than 4 mm ST Elevation in V3

EM@3AM: Total Hip Arthroplasty Complications

Sepsis Updates Relevant to the Emergency Physician

Penetrating chest trauma

Awake, and Paralysed: A Never Event

Another deadly triage ECG missed, and the waiting patient leaves before being seen. What is this nearly pathognomonic ECG?

Subarachnoid hemorrhage: ED presentation, evaluation, and management

How should we assess febrile infants? Results from the FIDO study

Major Trauma – Injuries by Assault

Febrile Seizures

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