Core EM

JULY 23, 2024

Hosts: Jonathan Kobles, MD Brian Gilberti, MD [link] Download Leave a Comment Tags: Agitation , psychiatry , Toxicology Show Notes Background/Epidemiology • Definition and Scope : Agitation encompasses behaviors from restlessness to severe altered mental states. IV/IM Regimens : • Medications : Droperidol, haloperidol, midazolam, ketamine.

Emergency Department 233

Emergency Department OR 233

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. This new ECG was still interpreted as STEMI and the patient was taken to the cath lab where the angiogram showed completely normal coronary arteries throughout. Unfortunately no echo was available.

OR 119

OR STEMI EMS ED 119

Pediatric EM Morsels

AUGUST 23, 2024

Concussion – Presentation [ Silverberg, 2023 ] There is no definitive test to diagnose concussion in the ED. It does NOT have structural brain damage visible on standard neuroimaging. In the research setting, abnormalities can be found via functional, blood flow, or metabolic imaging.

Emergency Department 243

Emergency Department OR ED EMS 243

Paramedics World

JANUARY 3, 2024

Feeling tired, weary, or exhausted? These sensations of fatigue seem to be an inevitable part of modern life. We blame fatigue on lack of sleep, overwork, stress, not enough exercise,… The post Fatigue: Is It Simple Tiredness or an Underlying Illness? appeared first on Paramedics World.

OR 52

OR Paramedic 52

Core EM

NOVEMBER 1, 2023

We discuss Electrical Storm (VT storm) and how to care for the very irritable heart. Monomorphic vs polymorphic (Torsades) may change management Wide QRS Fusion best Capture beats Concordance AV-dissociation Lab tests: Potassium, magnesium, troponins, TFTs, etc.

OR 130

OR 130

Core EM

JANUARY 25, 2024

Definition: Catatonia: A behavioral motor dysregulation syndrome marked by an inability to move normally despite full physical capacity, which can occur in the context of many underlying psychiatric and general medical disorders [4]. Epidemiology : Who typically suffers from catatonia? Who typically suffers from malignant catatonia?

MICU 246

MICU Emergency Department OR ED 246

EMS 12-Lead

APRIL 9, 2024

Many of the changes seen are reminiscent of LVH with “strain,” and downstream Echo may very well corroborate such a suspicion, but since the ECG isn’t the best tool for definitively establishing the presence of LVH, we must favor a subendocardial ischemia pattern, instead. He awoke earlier that morning in his usual state of health.

Coronary 290

Coronary ACS CAD ED 290

High Performance EMS

AUGUST 9, 2024

No matter how you decide to distinguish the priority of each request, it is triaged to standardize the rules for a consistent response definition. A brief delay on the low-priority call to obtain an appropriate match should not impact the immediate outcome or, potentially more importantly, the results of the next serious one.

BLS 264

BLS CAD Advanced Life Support Life Support 264

Core EM

JANUARY 25, 2024

Differentiating between the two is difficult as multiple proposed diagnostic criteria have yet to demonstrate sufficient sensitivity or specificity for a definitive diagnosis. The differential diagnosis for this patient includes Ventricular Tachycardia (VT) and Supraventricular Tachycardia (SVT) with aberrancy. Brady WJ, Skiles J.

Coronary 246

Coronary Emergency Department ED OR 246

Don't Forget the Bubbles

JUNE 19, 2023

However, there are no agreed-upon definitions for growth restriction, and there are significant knowledge gaps. Refer to your local or national guidelines to decide whether a patient is SGA or not, but remember that, depending on which definition is used, both over- and underdiagnosis can occur.

ALS 143

ALS OR 143

Core EM

JULY 23, 2024

We review Acute Respiratory Distress Syndrome Hosts: Sadakat Chowdhury, MD Brian Gilberti, MD [link] Download Leave a Comment Tags: Critical Care , Pulmonary Show Notes Definition of ARDS: Non-cardiogenic pulmonary edema characterized by acute respiratory failure.

Critical Care 130

Critical Care OR 130

Dr. Smith's ECG Blog

NOVEMBER 1, 2022

There is definite reperfusion. There was definite evolution of the ECG. He had been smoking an opiate and suddenly collapsed. He was ventilated with BVM on arrival. He awoke with naloxone. This EKG was recorded as part of a standing order for critical care. He denied any CP or SOB. Maybe there is some spontaneous reperfusion?

Overdose 52

Overdose OR Coronary ACS 52

Dr. Smith's ECG Blog

OCTOBER 24, 2018

Therefore, this does not meet the definition of myocardial infarction ( 4th Universal Definition of MI ), which requires at least one troponin above the 99% reference range. You can see the deficiency of the definition of MI. Because there is reciprocal ST depression in aVL, this should not be called early repol. But maybe not.

E-9-1-1 52

E-9-1-1 STEMI ACS Coronary 52

Pediatric EM Morsels

JULY 19, 2024

The definitions, typical healing course, timing of bleed, indications for tonsillectomy and the procedure itself have not changed much since our original morsel. Your support staff…depending on the amount of bleeding, you are about to have your hands full and may need IV access, medications, airway management, etc. Get IV access!

E-9-1-1 285

E-9-1-1 Epinephrine OR Emergency Department 285

Pediatric EM Morsels

AUGUST 2, 2024

It’s never comfortable and is often very distressing to have skin problems and infections, such as intertrigo , folliculitis , panniculitis , omphalitis , or even preseptal or periorbital cellulitis. It’s even more distressing when the skin problem affects the penis.

Allergic Reaction 152

Allergic Reaction OR EMS 152

The Skeptics' Guide to EM

DECEMBER 7, 2019

Most of the definition is in the name itself. * The name was not reassuring and the definition was vague. The Journal of Pediatrics published a systematic review of literature regarding the Management of ALTE in 2013 and one of the findings was that there was very little agreement in the literature on how to apply the definition.

CPR 130

CPR ALS OR 130

EMT Training Station

APRIL 5, 2023

With this in mind, it’s essential to show our appreciation and support for these incredible individuals. From practical tools and gadgets to thoughtful tokens of appreciation, these carefully-selected gifts are guaranteed to bring a smile to the face of the life-saving professional in your life.

EMT 52

EMT EMT Paramedic OR 52

Core EM

JUNE 3, 2024

Hosts: Jonathan Kobles, MD Brian Gilberti, MD [link] Download Leave a Comment Tags: Agitation , psychiatry , Toxicology Show Notes Background/Epidemiology • Definition and Scope : Agitation encompasses behaviors from restlessness to severe altered mental states. IV/IM Regimens : • Medications : Droperidol, haloperidol, midazolam, ketamine.

Emergency Department 130

Emergency Department OR 130

REBEL EM

AUGUST 7, 2023

Background: Getting a definitive airway in a critically ill trauma patient can be a stressful situation. PMID: 37058727 Clinical Question: Does delayed sequence intubation decrease peri-intubation hypoxia in trauma patients requiring definitive airway control compared to rapid sequence intubation? Anesth Analg 2023.

ALS 98

ALS OR EMS 98

ALiEM

SEPTEMBER 29, 2023

In cases where the nature of the missile is known, plain films or POCUS may be a reasonable first step, but CT imaging would be definitive. A 49-year-old male was triaged to the Fast Track area with complaints of an abrasion to the neck following an assault. He now presents requesting “Neosporin.”

ALS 177

ALS OR 177

ALiEM

DECEMBER 18, 2023

The regiSCAR diagnostic criteria is the most used diagnostic criteria and is based on a scoring system for possible, probable, or definite diagnosis. Of note, she reported that her dose of lamotrigine has been slowly uptitrated, most recently two days prior changing from 50 mg BID to 75 mg BID. Additional Images Physical Exam Vitals : T 39.6°C;

Emergency Department 177

Emergency Department OR 177

Emergency Medicine Cases

JUNE 29, 2021

Was CRASH-2 enough to be definitive, or does the classic EBM mantra of "we need more studies" remain true? Ken Milne of the The SGEM, Anton and Justin look at all the various potential indications for TXA and review the available evidence. Should we be using TXA for epistaxis, postpartum hemorrhage, hyphema or hemoptysis?

OR 130

OR EMS 130

Dr. Smith's ECG Blog

JANUARY 12, 2023

A repeat ECG was done at 1918: Interval improvement/resolution, without yet definitive reperfusion T wave inversions. In the chest leads , in addition to the QS in leads V1 and V2 — there is slight ST elevation and definite straightening of the ST segment takeoff in lead V2. Normal RV, no significant valvular stenosis or regurgitation.

OR 52

OR STEMI 52

The Good, The Bad & The Ugly Paramedic

NOVEMBER 15, 2020

Definitions of each may be complicated and conflicting, best left to qualified psychology professionals, but from a care provider’s point of view, narrowing down the basics can lead to some obvious and positive conclusions. In today’s climate of prehospital pressure, these are understandable negative reactions to excessive demand.

OR 52

OR EMS Paramedic Emergency Medical Services 52

EMDocs

SEPTEMBER 7, 2024

Patients may arrive with other concomitant injuries such as head or spine injuries and may be critically ill. Imaging CT scan of the abdomen and pelvis with IV contrast or CT angiogram of the abdomen is the imaging modality of choice. Majority of RPH will stabilize on their own and not require intervention. Mortality can varies between 5-20%.

EMS 73

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

Critical Care Scenarios

NOVEMBER 9, 2022

Reimbursers tend to like sepsis 3 definitions (qSOFA), core metrics may still use the older definitions. Many facilities may have their own policies on what definition to adopt. Requiring additional monitoring is also contributory. If you have all of this, you may be able to bill for “gram negative pneumonia.”

OR 100

OR 100

Core EM

APRIL 1, 2024

We review Acute Respiratory Distress Syndrome Hosts: Sadakat Chowdhury, MD Brian Gilberti, MD [link] Download Leave a Comment Tags: Critical Care , Pulmonary Show Notes Definition of ARDS: Non-cardiogenic pulmonary edema characterized by acute respiratory failure.

Critical Care 130

Critical Care OR 130

The Skeptics' Guide to EM

DECEMBER 9, 2023

SGEM listeners are probably familiar with the placebo effect, but can you give us a brief definition or description? Thanks for appraising OPAL and for engaging with me about it. There were lots of varied responses to OPAL. Most were positive and interested.

ALS 195

ALS OR 195

Emergency Medicine Cases

JANUARY 4, 2022

What are the best strategies to efficiently get the patient in cardiogenic shock to definitive care, whether that be the cath lab or the operating room? How can we best pick up occult cardiogenic shock before it floured shock kicks in?

Operating Room 130

Operating Room OR EMS 130

Dr. Smith's ECG Blog

JANUARY 27, 2024

In inferior aneurysm, we usually see QR-waves, whereas for anterior aneurysm, we see QS-waves (no R- or r-wave at all!). This ECG has Q-waves, but they are not very wide nor very deep, and so I doubt that the inferior STE is due to old MI. See these posts: Chest Pain, ST Elevation, and an Elevated Troponin: Should we Activate the Cath Lab?

STEMI 104

STEMI Coronary ACS ED 104

NVFC

MAY 21, 2024

118-63 expands the definition of public to include public safety entities. Section 926 of P.L. Additionally, this bill would allow public safety entities to use actively tethered UAS in zero-grid spaces when responding to emergencies. I applaud Senator Klobuchar and Senator Cramer for introducing the Honoring Our Fallen Heroes Act of 2023.

Public Safety 109

Public Safety Heart Attack First Responder Firefighter 109

Core EM

JANUARY 25, 2024

Written By: Kaitlynn Tracy, MD Edited By: Sean Schnarr, MD and Gregg Chesney, MD Definition/Background: Burns are classified as being major, moderate, or minor in severity. 4 Survival rate for all burn injuries is around 97%, which is a notable increase from 75% in the 1960’s.

ED 246

ED E-9-1-1 OR First Aid 246

Dr. Smith's ECG Blog

APRIL 17, 2023

No significant signal of terminal T wave inversion to suggest any reperfusion; this MI is in the process of completing. With this ECG alone, and no clinical context, it would be difficult for me to say if this OMI is subacute or old. QOH: "Not OMI, High confidence." NSTEMI is worthless garbage diagnosis! In this case it is OMI.

OR 52

OR STEMI ACS Emergency Department 52

REBEL EM

FEBRUARY 7, 2024

Take Home Points Infections are a leading cause of maternal mortality worldwide. Prompt recognition is critical in management. Most infectious processes will require admission and close observation for improvement or decompensation. References: Abbrescia, K. Sheridan (2003). “Complications of second and third trimester pregnancies.”

ED 96

ED ALS OR EMS 96

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

NAEMSP

MARCH 5, 2024

There has been literature to support the use of air in trauma-both because of the time to definitive care but also the critical care that can be started at the scene. Ground is the preferred method of transportation when it can provide necessary level of care and timely transport to definitive care.

Critical Care 52

Critical Care Medical Transportation CPR EMS 52

Dr. Smith's ECG Blog

SEPTEMBER 8, 2023

Chest lead findings in ECG #2 are are more pronounced than they were in ECG #1 — with now definite straightening of the ST segment in lead V2 — as well as ST flattening and depression now clearly seen in lead V3. This is diagnostic of Occlusion MI of the high lateral wall, either from circumflex or first diagonal.

OR 131

OR STEMI Coronary Emergency Department 131