Dr. Smith's ECG Blog

MAY 13, 2024

The 3rd definitely abnormal ( disproportionate ) T wave in ECG #2 — is in lead aVF ( within the BLUE rectangle in this lead ). Chest Pain – Benign Early Repol or OMI? He reported substernal chest pressure with radiation to his left arm that started at work several hours prior to arrival and had somewhat improved since onset.

OR 120

OR STEMI Heart Attack Coronary 120

Core EM

JANUARY 25, 2024

The definitive treatment of a necrotizing soft tissue infection is surgical debridement and removal of the necrotic tissue. It is a rapidly progressing infection that moves along fascial planes, often evading the immune system. This is a tricky diagnosis that can often be inconspicuous, so clinical gestalt is key. 2014;15(1):111-113.

E-9-1-1 246

E-9-1-1 Emergency Department OR 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

EMDocs

DECEMBER 1, 2024

typhi infection if treatment is refractory to supportive measures or conventional community-acquired pneumonia antibiotics Treat with atypical bacterial coverage (doxycycline, azithromycin, chloramphenicol, or fluoroquinolones) A 32-year-old woman presents to the ED with a fever and rash after returning from a trip to Southeast Asia. .:

EMS 104

EMS E-9-1-1 OR ED 104

The Skeptics' Guide to EM

SEPTEMBER 21, 2024

This has led to variability in EMS protocols, with some agencies including naloxone in their cardiac arrest protocols while others do not specifically recommend it, highlighting a gap in definitive guidance [6]. Your partner asks if you want to administer naloxone as well. Today’s study looks at the role of naloxone in OHCA.

Naloxone 260

Naloxone NARCAN Overdose CPR 260

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 281

Emergency Department OR ED EMS 281

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 ED OR 246

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

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

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

REBEL EM

NOVEMBER 6, 2024

Elbow Dislocation Definition: Disarticulation of the proximal radius & ulna bones from the humerus Epidemiology: Incidence Second most common joint dislocation (after shoulder) in adults Most commonly dislocated joint in children Accounts for 10-25% of all injuries to the elbow ( Cohen 1998 ) Posterolateral is the most common type of dislocation (..)

E-9-1-1 107

E-9-1-1 ACS OR Emergency Department 107

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

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-9-1-1 290

E-9-1-1 Epinephrine Emergency Department OR 290

Pediatric EM Morsels

SEPTEMBER 22, 2023

Definition A series of hemodynamic changes related to autonomic denervation and loss of sympathetic tone. Spinal shock is a phenomenon of transient, physiologic (rather than anatomic) complete loss of spinal cord function inferior to an injury. Refers to the Spinal Cord Function and Reflexes, not specifically hemodynamic issues.

E-9-1-1 304

E-9-1-1 Epinephrine ALS EMS 304

The Skeptics' Guide to EM

OCTOBER 20, 2018

Part of the difficulty with this topic is the inconsistent definition of contrast-induced nephropathy. A common definition is an increase in creatinine level by 25% or an absolute increase of 0.3 A common definition is an increase in creatinine level by 25% or an absolute increase of 0.3 mg/dL within 3 days.

Coronary 181

Coronary Emergency Department ALS OR 181

EMDocs

NOVEMBER 6, 2023

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. This post will focus on the key parts of the guideline that affect ED evaluation and management. Top 10 Take Home Pearls 1.

Naloxone 115

Naloxone OR BLS Overdose 115

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 125

OR STEMI EMS ED 125

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

Critical Care Scenarios

SEPTEMBER 18, 2024

“Definitive” TRALI (there is no longer a less definite category) is defined as: * No evidence of lung injury prior to transfusion * Onset within 6 hours after end of transfusion * P/F ratio <300 or SaO2 <92% on room air * Radiographic evidence of bilateral infiltrates with n.

OR 150

OR 150

ACEP Now

JULY 7, 2023

17,18 Given this, the advent of extracorporeal membrane oxygenation (ECMO) presents an opportunity to bridge care between traditional resuscitation of refractory VF patients in the ED and more definitive management in the catheterization lab. Out-of-hospital cardiac arrest is a commonly encountered entity in U.S. amiodarone or lidocaine).

Defibrillator 98

Defibrillator OR ALS Epinephrine 98

Pediatric EM Morsels

JUNE 7, 2024

Difficult vs. Severe Asthma: Definition and Limits of Asthma Control in the Pediatric Population. Single Maintenance And Reliever Therapy) This intelligent treatment regimen is with an ICS and a Long Acting Beta Agonist (LABA) [formoterol] given both for daily and rescue therapy. Moral of the Morsel Are they controlled? Prevention is key!

Emergency Department 208

Emergency Department EMS OR 208

EMDocs

NOVEMBER 13, 2024

Definition: SBP is an infection of the peritoneal ascitic fluid without an intra-abdominal focus of infection. Episode 110: Primary Spontaneous Bacterial Peritonitis Background: End-stage liver disease with cirrhosis and ascites is a major cause of death worldwide. Literature concerning risk with PPIs is controversial. increase in mortality.

E-9-1-1 105

E-9-1-1 ALS OR ED 105

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

Dr. Smith's ECG Blog

MAY 7, 2024

My response: "Definitely not polymorphic VT. Definitely atrial fibrillation. Here is the post cardioversion ECG: Definite pre-excitation (delta waves due to accessory pathway, "bypass tract"). Here is his presenting ECG, which was sent to me real time, along with the 2nd ECG below: Regular Narrow Fast without P-waves.

ALS 130

ALS OR 130

FOAMfrat

JANUARY 21, 2025

Identifying ECMO Candidates Early ECMO can serve as a vital bridge to definitive treatment for patients in cardiac arrest, especially those with shockable rhythms such as ventricular fibrillation (V-Fib) or ventricular tachycardia (V-Tach). In this episode, Alec Wilcox & I discuss ECPR eligibility & preparation. link] Kopra, J.,

CPR 98

CPR OR 98

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 First Aid OR 246

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 206

ALS OR 206

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

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

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. Welcome to the first episode of the Broomedocs podcast for 2025. Listen in and learn! WOMAN are so negative WOMAN-2 Trial Collaborators.

ED 101

ED OR ACS Critical Care 101

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

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

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

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

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

First 10 EM

OCTOBER 21, 2024

Let’s see if I can get myself cancelled by a group of physicians that are definitely smarter than me.) I love toxicologists, but it’s time for someone to call them out. (I I also love ranting. I am sick of the anti-science rhetoric.

OR 104

OR 104

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