Core EM

JANUARY 25, 2024

One week prior to ED arrival, the patient was becoming progressively despondent, less interactive with peers, exhibiting slow speech and movements, and was not eating. In Diagnostic and statistical manual of mental disorders (5th ed.). Catatonia: a case report by Brown Emergency Medicine. Burrow JP, Spurling BC, Marwaha R.

MICU 246

MICU Emergency Department OR ED 246

Pediatric EM Morsels

AUGUST 23, 2024

Concussion – Presentation [ Silverberg, 2023 ] There is no definitive test to diagnose concussion in the ED. Mild traumatic brain injury also includes a larger group of injuries that may have evidence of structural injury.

Emergency Department 243

Emergency Department OR ED EMS 243

Dr. Smith's ECG Blog

MARCH 13, 2023

An ED ECG, if recorded with pain, should show LAD OMI. So this ECG was immediately recorded: Indeed, as predicted, a patient with previous Wellens' waves who now definitely has chest pain has acute Occlusion, with new ST elevation in I, aVL, V2-V5. The Cath lab was activated.

ED 52

ED ACS Coronary Paramedic 52

Pulsara

AUGUST 1, 2024

They've created a new protocol that allows them to bypass the ED and take qualified patients directly to definitive care. Teams in Arkansas are finding new ways to improve outcomes for pediatric behavioral health patients.

ED 85

ED 85

Dr. Smith's ECG Blog

SEPTEMBER 11, 2024

When the patient arrived in the ED, he was still hypotensive in 70s, slowly improving with EMS fluids. Here is the ED ECG (a photo of the paper printout) What do you think? 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

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. Rosen’s Emergency Medicine. Philadelphia, PA: Elsevier Saunders; 2014:2331-2350. Gorgas, D. “Infections related to pregnancy.” ” Emerg Med Clin North Am 26 (2): 345-366, viii.

ED 96

ED ALS OR EMS 96

Dr. Smith's ECG Blog

JANUARY 27, 2024

Figure-1: I've labeled the initial ECG in the ED. KEY Point: All patients who present to the ED for new CP should promptly have a triage ECG recorded, that is then immediately interpreted by the ED physician. For clarity — I've labeled this initial ECG in Figure-1.

STEMI 104

STEMI Coronary ACS ED 104

EMDocs

DECEMBER 31, 2023

Without further ado, here is our list of top posts from 2023 based on viewership from you, the readers: Neurogenic Shock: Definition, Identification, and Management in the ED We start off the list with a clinical post from Kira Brayan and Jenny Beck-Esmay on diagnosing and managing neurogenic shock! This post from Mary E.

ED 74

ED EMS OR 74

Dr. Smith's ECG Blog

SEPTEMBER 12, 2024

The paramedic called the EM physician ahead of arrival and discussed the case and ECGs, and both agreed upon activating "Code STEMI" (even though of course it is not STEMI by definition), so that the acute LAD occlusion could be treated as fast as possible. So the cath lab was activated. Long term outcome is unavailable.

STEMI 86

STEMI EMS ACS ED 86

Dr. Smith's ECG Blog

MARCH 31, 2024

I simply texted back: "Definite posterior OMI." The person I was texting knows implicitly based on our experience together that I mean "Definite posterior OMI, assuming the patient's clinical presentation is consistent with ACS." The patient was a middle-aged female who had acute chest pain of approximately 6 hours duration.

STEMI 94

STEMI ACS ED 94

EMDocs

NOVEMBER 1, 2023

A 39-year-old male with history of achalasia with recent endoscopic dilation 24 hours prior presents to the ED for progressively worsening chest pain with radiation to his left shoulder. If there will be a delay in definitive management and there is evidence of intra-thoracic gastric contents, consider chest tube placement.

Critical Care 67

Critical Care ED EMS OR 67

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

EMDocs

SEPTEMBER 7, 2024

A 70-year-old female with a past medical history of hypertension, coronary artery disease s/p 2x drug eluting stent placement one month ago, atrial fibrillation on apixaban presents to the ED with weakness and lightheadedness. A 25-year-old man presents to the ED via EMS after he sustained a gunshot wound to the left flank.

EMS 73

EMS E-9-1-1 Operating Room OR 73

EMS 12-Lead

JULY 24, 2023

David Didlake Acute Care Nurse Practitioner Firefighter / Paramedic (ret) @DidlakeDW Expert commentary and peer review by Dr. Steve Smith [link] @smithECGBlog A 57 y/o Female with PMHx HTN, HLD, DM, and current use of tobacco products, presented to the ED with chest discomfort. A 12 Lead ECG was captured on her arrival.

Coronary 130

Coronary ACS CAD ED 130

EMDocs

SEPTEMBER 16, 2024

Author: Joshua Lowe, MD (EM Attending Physician, San Antonio, TX) // Reviewed by: Alex Koyfman, MD (@EMHighAK); Manpreet Singh, MD (@MPrizzleER); Brit Long, MD (@long_brit) The fluorescent lights above cast a clinical pallor over the bustling ED. Stay Calm Under Pressure: The ED can be chaotic, and emotions can run high.

Heart Attack 61

Heart Attack ED OR Emergency Department 61

EMergucate

MAY 30, 2016

Definition Transient LOC and loss of posture secondary to insufficient cerebral perfusion. Common – >25% lifetime incidence, 1% ED presentations … Continue reading →

EMS 100

EMS ED 100

Handtevy

SEPTEMBER 20, 2022

Case Report: The study discusses the case of a 17-year-old female who arrived at a community emergency department (ED) following a motor vehicle collision. Initially refusing emergency medical services, she was brought to the ED via a private vehicle. Her condition rapidly deteriorated, requiring intubation.

Operating Room 52

Operating Room Emergency Medical Services ED Emergency Department 52

Don't Forget the Bubbles

MAY 31, 2023

The DIMPLES study by PERUKI sought to investigate the incidence of new-onset diabetes in the paediatric population across the UK and Ireland, as well as the characteristics of these ED presentations, and to determine if SARS-CoV2 infection was involved. This meant 2746 ED presentations by 2618 individuals. Which patients were involved?

Emergency Department 135

Emergency Department ED OR ALS 135

ACEP Now

MAY 9, 2024

It has been well over a year since the controversial publication of the Agency for Healthcare Research and Quality (AHRQ) report on diagnostic errors in the emergency department (ED). percent of ED visits resulted in preventable death as result of diagnostic error. 1 The striking conclusions of this report included estimates that 0.1

Emergency Department 52

Emergency Department ICU ALS ACS 52

Critical Care Scenarios

JULY 11, 2021

pneumatically), then definitively addressed by Orthopedics at their convenience. Traction splinting is usually not done in the ED. Ultrasound (eFAST) and plain x-rays (chest and pelvis) are useful tools for rapid evaluation in the ED. Orthopedic injuries should be manually reduced and perfusion ensured, splinted (e.g.

Operating Room 100

Operating Room ICU ED OR 100

EMDocs

JUNE 6, 2023

Literature suggests we should avoid evaluating ocular pressure, though there are no case reports or peer reviewed data documenting extrusion of ocular contents from ocular pressure evaluation in the ED setting. Suspected OGI patients need a full ophthalmologic examination; however, assessment of ocular pressure is not recommended in the ED.

ED 75

ED OR 75

The Vocal CORD

JULY 15, 2024

I was lucky to get a job after high school for my summers and college breaks working the ED of our local hospital. I felt at home in the ED and knew it was the specialty for me. While I briefly entertained another specialty, it never felt right and emergency medicine was definitively the right choice for me.

ED 52

ED Ambulance 52

Dr. Smith's ECG Blog

NOVEMBER 29, 2023

Both cases had an EMS ECG that was transmitted to the ED physician asking "should we activate the cath lab?" On arrival to the ED, while waiting for cath lab team, he obtained another ECG: You can now see the full voltage of the high-voltage QRS, likely with some degree of LVH. Both were awake and alert with normal vital signs.

OR 119

OR STEMI EMS ED 119

Dr. Smith's ECG Blog

JUNE 27, 2024

By Sofiya Diurba MD, reviewed by Meyers, Grauer A woman in her 50s with PMH known RBBB and prior syncopal events presents to the ED for five syncopal events over the last 24 hours. This is her first ECG in the ED: What do you see? Each event is associated with a prodrome of mild substernal CP, SOB, and “brain fog.”

ED 121

ED OR Emergency Department Emergency Manager 121

EMS 12-Lead

MAY 8, 2022

They are definitely high in amplitude and, intermittently, appear to disproportionately tower over the respective QRS. This is critical for the EMS provider, or ED clinician, as identification of Grade I ischemia (aka, HATW’s) addresses the culprit lesion at the earliest opportunity with excellent downstream prognosis for the patient. [2]

STEMI 130

STEMI ED EMS Firefighter 130

ACEP Now

JUNE 7, 2023

The performance of EDs in 2020 and into 2021 changed abruptly, and that carried through into 2022. EDs weathered attacks from a variety of sources in recent years. ED leaders worked to develop new physician documentation and coding guidelines that needed to be implemented at the beginning of 2023.

Emergency Department 52

Emergency Department ED EMS Ambulance 52

EMDocs

APRIL 2, 2024

Check the pulse RSI= Resuscitation Sequence Intubation Hypoxia, Hypotension, and Acidosis are the reason patients code during/post intubation These patients are super high risk for all 4 Optimize first pass success – Induction agent + paralytic Unconscious patients will still have muscle tone Induction Ketamine or Etomidate at half doses (i.e.,

CPR 92

CPR STEMI Epinephrine ICU 92

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. In: Sherman SC eds. Vertebral Osteomyelitis and Spinal Epidural Abscess: An Evidence-based Review. J Spinal Disord Tech. Semin Arthritis Rheum.

E-9-1-1 94

E-9-1-1 ALS ED OR 94

High Performance EMS

MARCH 1, 2022

As we begin to wind down on the pandemic-level of constant 911 calls and the endless hours waiting on a room in the ED, we find ourselves in a time to reflect a little before our next call. Like so many services, we have a new influx of eager young professionals.

AEMT 100

AEMT EMS ED OR 100

The Skeptics' Guide to EM

JULY 25, 2020

The bottom line from that episode on skin glue for peripheral intravenous lines was: “Skin glue does appear to decrease the failure rate of IVs in patients admitted to hospital from the ED at 48 hours. It was great that it started with a definition of evidence-based medicine (EBM).

ED 130

ED ALS OR 130

Dr. Smith's ECG Blog

JULY 25, 2024

The patient was brought to the ED and had this ECG recorded: What do you think? Confirmation of sinus tachycardia should be easy to verify when the heart rate slows a little bit ( as the patient's condition improves ) — allowing clearer definition between the T and P waves. After 1 mg of epinephrine they achieved ROSC.

Defibrillator 113

Defibrillator Coronary Epinephrine ACS 113

Dr. Smith's ECG Blog

DECEMBER 24, 2023

If I saw this patient in the ED, I would electrically cardiovert back to sinus rhythm. Additional Management Questions: The patient presented to the ED for palpitations — and was initially in AFlutter with 2:1 AV conduction. She apparently was discharged from the ED in the same rhythm ( albeit with the slightly increased atrial rate ).

ED 128

ED OR Emergency Manager Emergency Management 128

Don't Forget the Bubbles

MAY 15, 2023

Although hypoglycaemia is one of the most common paediatric emergencies, consensus on a definition and investigations have not been reached. Even the definition of hypoglycaemia itself is a contentious subject. How do I measure hypoglycaemia in the ED? Again, this is a general guide only. The Journal of Pediatrics.

ED 101

ED Plasma OR ALS 101

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). Blinding procedures were well constructed as to mask group allocation.

ALS 144

ALS OR EMS ED 144

The Skeptics' Guide to EM

NOVEMBER 1, 2022

AEM October 2022 Guest Skeptic: Dr. Justin Morgenstern is an emergency physician and the creator of the #FOAMed project called First10EM.com Case: A 19-year-old man presents to the emergency department (ED) with his first time anterior should dislocation after trying to recreate one of his favourite scenes in the movie Lethal Weapon.

ALS 152

ALS Emergency Department OR ED 152

Dr. Smith's ECG Blog

SEPTEMBER 19, 2023

Initial ED ECG: What do you think? Definitive diagnosis that ECG #1 is in fact VT is more than academic. That said — We can definitively diagnose AV dissociation in today's tracing! Once I knew that at least 1 definite underlying P wave was present — I diligently looked for more. Why did I say that?

Coronary 138

Coronary OR EMS ED 138

REBEL EM

FEBRUARY 22, 2023

Open angle Closed angle Definitions Increased resistance to aqueous outflow through the trabecular meshwork. et al, Emergency Medicine Clinical Essentials ed 2. Ophthalmology, in Marx J et al (eds): Rosens Emergency Medicine: Concepts and Practice, ed 9. Transient vision loss defined as vision loss <24 hours.

Emergency Department 52

Emergency Department ALS ED Coronary 52