Dr. Smith's ECG Blog

OCTOBER 21, 2023

For example — VT becomes much more likely if QRS morphology during WCT is not consistent with some known form of conduction defect ( See My Comment in the May 5, 2020 post in Dr. Smith's ECG Blog for more on "My Take" re criteria for distinguishing between SVT vs VT ). Figure-1: The initial ECG in today's case.

OR 136

OR 136

REBEL EM

MAY 27, 2024

What they did: Prospective randomized controlled trial, unblinded, multicenter study Conducted from January 2017 to December 2022 Patients with confirmed PSVT were randomly assigned to receive MVM, IV Adenosine, or combined therapy. This absence of detail leaves the study open to bias. Evidence suggests that a weight-based dosing approach (0.1

OR 137

OR E-9-1-1 ED ALS 137

EMOttawa

MAY 31, 2024

Findings: There was no significant difference in 30-day all-cause mortality […] The post Restrictive or Liberal Transfusion Strategy in Myocardial Infarction and Anemia appeared first on EMOttawa Blog.

OR 60

OR ALS 60

EMOttawa

MAY 6, 2024

Question and Methods: This multi-centre, triple-blind, double dummy RCT in China aimed to evaluate the functional outcomes and safety of intravenous tirofiban as compared to aspirin in moderate to severe strokes […] The post Tirofiban for Stroke without Large or Medium-Sized Vessel Occlusion appeared first on EMOttawa Blog.

OR 60

OR ALS 60

Emergency Medicine Cases

DECEMBER 16, 2019

In this ECG Cases blog we look at seven patients with potentially ischemic symptoms and subtle ECG changes in the lateral leads. Which had acute coronary occlusion? Introducing the concept of Occlusion MI - a paradigm shift in ECG diagnosis of MI. The post ECG Cases 4: Lateral STEMI or Occlusion MI?

STEMI 130

STEMI OR Coronary 130

Emergency Medicine Cases

OCTOBER 22, 2019

In this ECG Cases blog we present ECGs from 7 patients who presented with chest pain and mild anterior ST elevation. Can you identify which were early repolarization and which were anterior STEMI? The post ECG Cases 2: Early Repolarization or Anterior STEMI? appeared first on Emergency Medicine Cases.

STEMI 130

STEMI OR EMS 130

Dr. Smith's ECG Blog

SEPTEMBER 18, 2024

For more on MINOCA — See My Comment in the November 16, 2023 post in Dr. Smith's ECG Blog ). Review of the 2 ECGs in today's case is insightful ( Figure-1 ): The initial ECG shows sinus rhythm, LAHB and meets Peguero Criteria for LVH ( See My Comment in the August 15, 2022 post of Dr. Smith's ECG Blog for more on LVH criteria ).

Coronary 115

Coronary ACS OR EMR 115

Dr. Smith's ECG Blog

MARCH 28, 2024

Per EMS report, patient believes he has been in atrial fibrillation for 5 days, since coming down with flu-like illness with rhinorrhea, productive cough, SOB. Patient is on rivaroxaben, carvedilol, and dofetilide (to suppress atrial fib -- rhythm control). He states that he maybe missed a dose or two during recent illness. SVT with aberrancy?

OR 122

OR Emergency Department Ambulance EMS 122

Emergency Medicine Cases

APRIL 2, 2024

In this ECG Cases blog, Jesse McLaren and Rajiv Thavanathan explore how ECG and POCUS complement each other for patients presenting to the emergency department with shortness of breath or chest pain. They explain complementary diagnostic insights into pericardial effusion and cardiac tamponade, occlusion MI and RV strain.

Emergency Department 307

Emergency Department OR STEMI EMS 307

Dr. Smith's ECG Blog

NOVEMBER 11, 2024

It can be seen in other forms of heart block as well (such as complete heart block). See Ken Grauer 's comment below for more on this. As this patient is scheduled for imminent elective surgery, it is important to determine whether this is Mobitz I (benign) or Mobitz II (requires pacing). So.Which is it? History is often helpful.

OR 71

OR E-9-1-1 Coronary 71

Dr. Smith's ECG Blog

SEPTEMBER 25, 2024

A healthy 45-year-old female presented with chest pain, with normal vitals. The computer interpretation was “ST elevation, consider early repolarization, pericarditis or injury.” What do you think? There’s normal sinus rhythm, normal conduction, borderline right axis, and normal voltages. There’s TWI in aVL but this is concordant to its QRS.

OR 66

OR STEMI ACS Coronary 66

EMOttawa

OCTOBER 31, 2024

There is an ED prevalence ranging from 7-24%, with increased mortality rates […] The post Delirium revisited appeared first on EMOttawa Blog. Delirium is often the initial manifestation of an underlying acute illness and can be present before fever, tachypnea, tachycardia, or hypoxia.

ED 116

ED OR EMS 116

Emergency Medicine Cases

FEBRUARY 13, 2024

In this month's ECG Cases blog Dr. Jesse McLaren reviews interpretation of the pre-arrest ECG: identifying high risk ECGs requiring empiric treatment like calcium for hyperkalemia, magnesium for long QT, or reperfusion for Occlusion MI; the intra-arrest ECG: identifying pseudo-PEA; and post-arrest ECG: the importance of serial ECGs to reduce false (..)

STEMI 277

STEMI OR EMS 277

REBEL EM

NOVEMBER 20, 2023

Early expeditious definitive hemorrhage control is a major focus in trauma resuscitation. Patients with torso hemorrhage present a clinical conundrum often requiring interventional radiology or surgery, both of which take time to mobilize. 2 Despite these recommendations there are no randomized clinical trials to help guide practice until now.

OR 91

OR Emergency Medical Technician CPR Emergency Medical Services 91

Emergency Medicine Cases

SEPTEMBER 12, 2023

The post ECG Cases 45 ECG in Weakness and Neurological Symptoms appeared first on Emergency Medicine Cases.

Coronary 296

Coronary OR EMS 296

ALiEM

FEBRUARY 5, 2024

8 blog posts met our standard of online excellence and were approved for residency training by the AIR Series Board. Digital Impact Factor: A Quality Index for Educational Blogs and Podcasts in Emergency Medicine and Critical Care. More specifically, we identified 3 AIR and 5 Honorable Mentions. Please go to the above link.

Overdose 215

Overdose Critical Care EMS Emergency Department 215

NAEMSP

APRIL 15, 2024

Editing by James Li, MD NAEMSP Blog Editor The post Article Bites #48: Clinical Care and Restraint of Agitated or Combative Patients appeared first on NAEMSP. Article Summary by Sarah Fabiano, MD, FACEP, FAAEM Kupas DF, Wydro GC, Tan DK, Kamin R, Harrell AJ 4th, Wang A. Prehosp Emerg Care 2021 Sep-Oct;25(5):721-3. Epub 2021 Jun 7.

OR 52

OR Emergency Medical Technician Emergency Medical Services EMS 52

ALiEM

NOVEMBER 3, 2023

8 blog posts met our standard of online excellence and were approved for residency training by the AIR Series Board. Digital Impact Factor: A Quality Index for Educational Blogs and Podcasts in Emergency Medicine and Critical Care. More specifically, we identified 3 AIR and 5 Honorable Mentions. Please go to the above link.

Critical Care 211

Critical Care Emergency Department EMS ALS 211

EMOttawa

JUNE 24, 2024

Findings: The study findings demonstrate that parenteral ibuprofen in […] The post Comparing the efficacy of intravenous morphine versus ibuprofen or the combination of ibuprofen and acetaminophen in patients with closed limb fractures: a randomized clinical trial appeared first on EMOttawa Blog.

OR 52

OR ALS 52

Dr. Smith's ECG Blog

NOVEMBER 29, 2023

Smith : this ECG is definitely not OMI, but could be mistaken for Swirl pattern, which is a septal OMI with STE in V1 and STD in V6. See these cases: Precordial Swirl -- 20 cases of Swirl or Look-Alikes Subsequent serial high sensitivity troponin I measurements were all below the level of detection. AMI was ruled out altogether.

OR 116

OR STEMI EMS ED 116

Dr. Smith's ECG Blog

OCTOBER 15, 2022

LBBB also has discordant STE in V1-V3 and STD in V5, 6 -- I will not be giving examples of this, as they are readily available all over the blog. I further explore this concept in detail in My Comment — at the bottom of the page in the February 6, 2020 post in Dr. Smith's ECG Blog. Chest Pain and RBBB.

OR 52

OR E-9-1-1 STEMI 52

Emergency Medicine Cases

OCTOBER 17, 2023

In this ECG Cases blog Dr. Jesse McLaren guides us through 10 cases, driving home the points that sepsis is a common cause of rapid Afib and diffuse ST depression with reciprocal ST elevation in aVR, myo/pericarditis is a diagnosis of exclusion, endocarditis or lyme carditis can cause AV block, PE can cause low grade fever and ECG signs of acute RV (..)

OR 229

OR STEMI EMS 229

Dr. Smith's ECG Blog

OCTOBER 8, 2024

For more on Precordial Swirl — See the October 15, 2022 post in Dr. Smith's ECG Blog ). In support of my impression that the ST-T wave changes in the chest leads are acute until proven otherwise — is the ST segment flattening and depression in lead II — as well as the J-point ST depression in lead I ( BLUE arrows in these leads ).

OR 108

OR STEMI ICU Coronary 108

Dr. Smith's ECG Blog

MAY 29, 2024

Written by Pendell Meyers Two patients with acute chest pain. Do either, neither, or both have OMI and need reperfusion? Patient 1: Patient 2: Patient 1: A man in his 40s with minimal medical history presented with acute chest pain radiating to his R shoulder.

CAD 101

CAD OR STEMI 101

ALiEM

OCTOBER 14, 2023

6 blog posts met our standard of online excellence and were approved for residency training by the AIR Series Board. Digital Impact Factor: A Quality Index for Educational Blogs and Podcasts in Emergency Medicine and Critical Care. More specifically, we identified 3 AIR and 3 Honorable Mentions. Please go to the above link.

Critical Care 169

Critical Care EMS Emergency Department ALS 169

Emergency Medicine Cases

AUGUST 8, 2023

In this ECG Cases blog with Dr. Jesse McLaren we interpret 10 ECG cases and explore cardiac, metabolic and GI causes: We consider anginal equivalents, and look for ECG signs of Occlusion MI, including subacute occlusion from delayed presentations.

STEMI 205

STEMI OR EMS 205

EMOttawa

NOVEMBER 14, 2024

Yet, the reliance on these screens is fraught with inaccuracies, clinical irrelevance, and significant ethical concerns, particularly from […] The post Blurred Lines: The Ethical Pitfalls of Urine Drug Screens appeared first on EMOttawa Blog.

Emergency Department 71

Emergency Department ED OR 71

Dr. Smith's ECG Blog

SEPTEMBER 9, 2024

NOTE: For review of 20 cases of "Swirl" vs Swirl "Look-Alikes" — Check out the October 15, 2022 post in Dr. Smith's ECG Blog. In a large proportion of cath labs, the operator would probably have ended the case at this point. Smith comment : a very high proportion of MINOCA are ruptured plaque with lysed thrombus.

OR 66

OR Coronary ACS EMS 66

EMOttawa

JANUARY 25, 2024

With both ER and ICU experience, this post acts as a quick […] The post Mechanical Ventilation Basics appeared first on EMOttawa Blog. Mechanical ventilation has a lot of nuance associated with it, but a lot of reference guides focus on care in the ICU.

ICU 141

ICU ED OR Critical Care 141

Dr. Smith's ECG Blog

SEPTEMBER 22, 2023

This is diagnostic of full reperfusion.] An old ECG was found: As you can see, this patient has zero baseline STE, and normal T-waves. You never know if a patient's baseline has normal large STE or complete absence of STE, or somewhere in between. 90% of normals have some STE in V2 and V3. I focus my comment on this initial ECG in today's case.

OR 123

OR STEMI Coronary 123

The Skeptics' Guide to EM

SEPTEMBER 21, 2024

Background: We’ve discussed out-of-hospital cardiac arrest (OHCA) at least once or twice on the SGEM (see long list at end of blog). You and your partner initiate high-quality CPR, place a supraglottic airway, establish intra-osseous (IO) access and administer epinephrine. Your partner asks if you want to administer naloxone as well.

Naloxone 242

Naloxone NARCAN Overdose CPR 242

EMOttawa

JUNE 27, 2024

Originating in the 1960s, this practice was propelled by anecdotal evidence and early case reports suggesting that un-immobilized cervical spine injuries could worsen […] The post Spinal Immobilization: a Twisted Tale appeared first on EMOttawa Blog.

EMS 106

EMS OR Critical Care 106

FirstNet Authority

NOVEMBER 19, 2024

Follow us on Twitter , Facebook , Instagram , and LinkedIn for the latest FirstNet Authority updates. For information on FirstNet products and services or to access your subscriber account, visit FirstNet.com. [link]

Public Safety 64

Public Safety First Responder OR 64

Dr. Smith's ECG Blog

DECEMBER 12, 2022

Here is the OMI progression of ECG findings for review: You can see that OMI ECG findings must "deflate" and pass through normal or near-normal in order to get to reperfusion findings. In other words, to get from hyperacute T waves and STE to terminal T wave inversion, the ST and T wave must pass transiently through a state of near-normal.

OR 52

OR ACS STEMI Coronary 52

ALiEM

AUGUST 19, 2024

Tips for the personal statement Mentioned Resources CORD website: New MyERAS® Application: Guidance for Emergency Medicine Read and Listen to the Other EM Match Advice Episodes Blog posts: [link] Author information Sara M. A new section allows you to explaining any unplanned training extensions and interruptions.

EMS 152

EMS OR 152

FirstNet Authority

SEPTEMBER 11, 2024

Follow us on Twitter , Facebook , Instagram , and LinkedIn for the latest FirstNet Authority updates. For information on FirstNet products and services or to access your subscriber account, visit FirstNet.com.

First Responder 105

First Responder Public Safety OR 105

REBEL EM

OCTOBER 16, 2024

Rezaie, MD (Twitter/X: @srrezaie ) The post REBEL Core Cast 129.0 – Gastric Lavage appeared first on REBEL EM - Emergency Medicine Blog. Take Home Points Orogastric lavage may still play an important role in treatment of the overdose patient. Strongly consider orogastric lavage in a patient who has taken an overdose of drugs that.

Overdose 104

Overdose EMS OR 104