Dr. Smith's ECG Blog

DECEMBER 27, 2023

Cardiology consult note written around that time documents that "Pain improved with NTG, morphine in ED but still present." In an attempt to clarify language, a consensus definition was developed. mV in 2 or more contiguous leads (excluding V1-V3) The QRS duration should be < 120 ms This definition is not perfect.

E-9-1-1 131

E-9-1-1 OR Coronary ACS 131

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. Patient Case: History: A 60-year-old male with history of schizophrenia and depression on multiple unknown antipsychotic medications presents with unresponsiveness x 1 day.

MICU 246

MICU Emergency Department ED OR 246

EMDocs

DECEMBER 1, 2024

A 52-year-old male with a history of essential hypertension presents to your South Texas ED for his second visit this week complaining of indolent fever, shortness of breath, pleuritic chest pain, and a rash on his trunk and extremities. We’ll keep it short, while you keep that EM brain sharp.

EMS 105

EMS E-9-1-1 OR ED 105

Core EM

JANUARY 25, 2024

The Case A 41-year-old male presents to the ED with constant palpitations for one day. Differentiating between the two is difficult as multiple proposed diagnostic criteria have yet to demonstrate sufficient sensitivity or specificity for a definitive diagnosis. Discussion Fascicular VT is a distinct subgroup of idiopathic VT.

Coronary 246

Coronary Emergency Department ED OR 246

Broome Docs

JANUARY 27, 2025

These results are not definitive, but considering the rarity of demyelination, and the magnitude of the mortality results, this should probably influence clinical practice until we get the proper RCTs. The protocol used the ADD score, a POCUS echo protocol and D-dimer to try and exclude AAS in the ED. Listen in and learn!

ED 101

ED OR ACS Critical Care 101

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. Refers to the Spinal Cord Function and Reflexes, not specifically hemodynamic issues. Moral of the Morsel Anatomy Matters!

E-9-1-1 304

E-9-1-1 Epinephrine ALS EMS 304

Core EM

OCTOBER 16, 2024

Annie: I developed an interest in EM while working as a scribe in the ED during college. In addition to what Charlotte and Nick said, I can envision myself staying calm in the stressful situations that come up in the ED. I’m also passionate about advocacy, so I appreciate the focus on the social safety net.

ED 100

ED EMS Critical Care OR 100

Core EM

SEPTEMBER 24, 2024

Annie: I developed an interest in EM while working as a scribe in the ED during college. In addition to what Charlotte and Nick said, I can envision myself staying calm in the stressful situations that come up in the ED. I’m also passionate about advocacy, so I appreciate the focus on the social safety net.

ED 100

ED EMS Critical Care OR 100

The Skeptics' Guide to EM

DECEMBER 21, 2019

Outside of his academic duties, he works clinically in the adult ED at Spectrum Health in Grand Rapids, Michigan, the tertiary care center for Western Michigan. Only then would there be definitive evidence for the efficacy of parachutes. Date: December 17th, 2019 Reference: Reeves and Reynolds. It would be a cross over trial.

OR 100

OR ALS ED 100

Dr. Smith's ECG Blog

NOVEMBER 22, 2023

While in the ED, patient developed acute dyspnea while at rest, initially not associated with chest pain. The patient had no chest symptoms until he had been in the ED for many hours and had been undergoing management of his DKA. The patient was under the care of another ED physician. Another ECG was recorded: What do you think?

ED 119

ED Coronary CAD STEMI 119

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 125

OR STEMI EMS ED 125

REBEL EM

NOVEMBER 20, 2023

Early expeditious definitive hemorrhage control is a major focus in trauma resuscitation. Background: Hemmorhage is a major cause of preventable death in trauma patients. Patients with torso hemorrhage present a clinical conundrum often requiring interventional radiology or surgery, both of which take time to mobilize. 2023;e2320850.

OR 91

OR Emergency Medical Technician CPR Emergency Medical Services 91

ACEP Now

JULY 7, 2023

emergency departments (EDs), with statistics reporting more than 356,000 out-of-hospital cardiac arrests per year. emergency departments (EDs), with statistics reporting more than 356,000 out-of-hospital cardiac arrests per year. Out-of-hospital cardiac arrest is a commonly encountered entity in U.S. amiodarone or lidocaine).

Defibrillator 98

Defibrillator OR ALS Epinephrine 98

Core EM

OCTOBER 16, 2024

Author: Natalie Bertrand, MD Editor: Naillid Felipe, MD Background: Definition: adverse reaction to blood product administration Incidence: more common in children than adults, except for delayed hemolytic transfusion reactions Allergic (non-anaphylaxis) – Platelets 1-3%; RBCs 0.1-0.3%

Allergic Reaction 188

Allergic Reaction Plasma ED Epinephrine 188

EMDocs

NOVEMBER 13, 2024

Definition: SBP is an infection of the peritoneal ascitic fluid without an intra-abdominal focus of infection. Major takeaway: Consider SBP in any patient who comes into the ED with ascites. Primary spontaneous bacterial peritonitis (SBP) is one of the most common infections in those with cirrhosis and ascites. increase in mortality.

E-9-1-1 105

E-9-1-1 ALS OR ED 105

EMDocs

NOVEMBER 6, 2023

This post will focus on the key parts of the guideline that affect ED evaluation and management. Author: Brit Long, MD (@long_brit) // Reviewed by Alex Koyfman, MD (@EMHighAK) The American Heart Association 2023 Guideline for managing cardiac arrest or life-threatening toxicity due to poisoning was recently released. COR Harm, LOE B-R.

Naloxone 115

Naloxone OR BLS Overdose 115

EMDocs

FEBRUARY 26, 2024

The ED clinician should inquire about a relevant history of HIV infection, malignancy, high-dose corticosteroid use, chemotherapy, organ transplant, or use of immunosuppressive drugs for other indications. She reports occasional central chest pain exacerbated by coughing. 0 C, and has no jaundice. of PJP patients with sensitivity of 86.5%

E-9-1-1 110

E-9-1-1 ED ALS OR 110

EMDocs

SEPTEMBER 25, 2023

Also known as Facilitated intubation (FI), the use of intubating with only a sedative was an accepted alternative intubation technique prior to those definitive studies in the late 1990s but quickly was abandoned for RSI in all emergent endotracheal intubations (ETI) (8,9).

ED 92

ED Emergency Department ALS Paramedic 92

ACEP Now

NOVEMBER 8, 2024

9 Here are some of the key conditions that are considered neurodivergent and that emergency physicians are likely to encounter: Autism Spectrum Disorder (ASD): Although the definition of autism has changed over time, in general, it refers to a group of complex developmental brain disorders.

Emergency Department 52

Emergency Department ED OR ALS 52

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. In inferior aneurysm, we usually see QR-waves, whereas for anterior aneurysm, we see QS-waves (no R- or r-wave at all!).

STEMI 117

STEMI Coronary ACS ED 117

REBEL EM

FEBRUARY 15, 2024

Background: Patients with decreased level of consciousness due to alcohol, drugs, or medications commonly present to the ED. These patients can be at risk of vomiting and aspiration and often prompts clinicians to pursue definitive airway management to avoid pneumonia and other complications.

ICU 141

ICU ALS ED OR 141

EMS 12-Lead

APRIL 2, 2022

1, 2] The most clinically useful definition to account for this entire constellation is intraventricular conduction delay. Upon arrival he was found alert and oriented, and without gross distress. He denied difficulty breathing, epigastric pain, or chest discomfort. He denied any chest discomfort, or difficulty breathing. Figure 1-2.

ALS 130

ALS STEMI Coronary OR 130

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

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

Dr. Smith's ECG Blog

MAY 3, 2024

But this time the Queen gets it wrong (thinks it is not OMI): There were runs of VT: Tha patient arrived in profound shock and had an ED ECG: Now there is some evolution to include the ST elevation (rather than ST depression) in V4-V6. There is STE in aVR. Thus, there is high lateral OMI with diffuse ST depression.

ACS 127

ACS ED Coronary EMS 127

EMDocs

OCTOBER 19, 2024

2][3] Definitive diagnosis is made by laryngoscopy or bronchoscopy showing normal or mildly erythematous epiglottis and an erythematous, edematous trachea with thick mucopurulent exudates. [3] Question: What’s the next step in your evaluation and treatment, and what is the potentially life-threatening diagnosis?

EMS 110

EMS E-9-1-1 Epinephrine OR 110

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. This series provides evidence-based updates to previous posts so you can stay current with what you need to know.

Critical Care 93

Critical Care ED EMS OR 93

Dr. Smith's ECG Blog

SEPTEMBER 8, 2023

Keep in mind the presenting History ( ie, a 50yo presenting to a rural ED with a 1-hour history of CP radiating to the back and jaw — and an initial ECG labeled as "normal" by the computer interpretation ). This is diagnostic of Occlusion MI of the high lateral wall, either from circumflex or first diagonal.

OR 130

OR STEMI Coronary Emergency Department 130

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

Critical Care Scenarios

JULY 11, 2021

pneumatically), then definitively addressed by Orthopedics at their convenience. 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.

Operating Room 100

Operating Room ICU ED OR 100

Dr. Smith's ECG Blog

DECEMBER 29, 2018

The T-waves are not definitively hyperacute. There is definite v oltage for LVH. Clearly, more information is needed before a definite decision can be reached — but the “onus of proof” is on the clinician to rule out acute LAD occlusion. There is a small amount of STE in V2 and V3, with a very small amount of STD in V4-V6.

OR 52

OR STEMI Coronary ED 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 115

CPR STEMI Epinephrine ICU 115

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 123

ALS Emergency Department OR ED 123

REBEL EM

APRIL 17, 2023

Clinical evaluation may prove difficult since many PTA and peritonsillar cellulitis symptoms overlap. Physical examination is approximately 75% sensitive and 50% specific for identifying PTA. CT and aspiration or drainage are considered the gold standard for diagnosis. Article: Kim DJ et al. Acad Emerg Med. 2023 Jan 10. Epub ahead of print.

ALS 129

ALS OR ED EMS 129

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 124

Defibrillator Coronary Epinephrine ACS 124

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. A b rief chart review revealed his most recent echo in 2018, with LV EF 67%, “very small” inferior wall motion abnormality. This was shown to me with no clinical information and I said "It is VT until proven otherwise."

Coronary 139

Coronary OR EMS ED 139

Dr. Smith's ECG Blog

JANUARY 31, 2024

Regarding Today's Initial ECG: Today's patient is a 60-something man who presented to the ED with CP ( C hest P ain ) that awakened him from sleep — but which quickly resolved, and was no longer present at the time ECG #1 was recorded. What can be said about ECG #1 — is that anterior MI has definitely occurred at some point in the past.

OR 109

OR ED 109