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 108

OR STEMI Heart Attack Coronary 108

The Skeptics' Guide to EM

JANUARY 30, 2021

This was based on two definitions. Steve is currently an Assistant Professor in the Department of Family Medicine at Western University (London, Ontario) […] The post SGEM#317: Dese Bones Gonna Heal Again – With or Without a Non-Selective NSAID first appeared on The Skeptics Guide to Emergency Medicine. J Bone Joint Surg Am.

OR 130

OR ALS 130

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

Core EM

JANUARY 1, 2025

Definition A rapidly progressive, life-threatening infection of the deep soft tissues. Surgical Consultation Early surgical exploration is often the definitive diagnostic step. Not definitive but can guide suspicion. High mortality and morbidity underscore the need for vigilance. Bacteroides, Clostridium, Peptostreptococcus).

Critical Care 130

Critical Care ICU OR 130

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 278

Emergency Department OR ED EMS 278

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 ALS 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

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 239

Naloxone NARCAN Overdose CPR 239

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-9-1-1 286

E-9-1-1 Epinephrine Emergency Department OR 286

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-9-1-1 300

E-9-1-1 Epinephrine ALS EMS 300

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 174

Coronary Emergency Department ALS OR 174

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 152

OR 152

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

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

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 116

OR STEMI EMS ED 116

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

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 206

Emergency Department OR EMS 206

Dr. Smith's ECG Blog

NOVEMBER 27, 2024

In Figure-1 — Since this patient is having new CP, this T wave disproportionality in 4 of the limb leads by definition represents hyperacute T waves that mandate prompt cath. The early HATW model correctly identifies the HATWs in the inferior leads. Smith simply provides links to a series of such pictures for us to embed in our memory.

STEMI 110

STEMI OR 110

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

OCTOBER 28, 2024

Case Question: What is the definitive management for a nephroblastoma? The definitive management of a Wilms tumor is a multidisciplinary approach, with primary nephrectomy followed by a tailored chemotherapy regimen as the gold-standard treatment in the US. fusion_text] Additional Images Physical Exam Vitals : Temp 97.9 °F

ED 161

ED OR 161

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 95

Naloxone OR Overdose BLS 95

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

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

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 198

ALS OR 198

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 117

ALS OR 117

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

The Skeptics' Guide to EM

NOVEMBER 16, 2024

One definition of AI is a computer system capable of performing tasks that typically require human intelligence, such as pattern recognition, decision-making, and language processing. The Chief of EM wants to be sure that any new system they introduce will enhance workflow and not add to clinicians’ cognitive burden.

ICU 214

ICU Emergency Department ALS EMS 214

Dr. Smith's ECG Blog

NOVEMBER 11, 2024

The small-but-definitely-present initial q wave in lead V2 ( within the dotted RED circle in Figure-1 ) is not a normal finding with this RBBB considering that there definitely is a typical triphasic ( rsR' ) QRS complex in neighboring lead V1. It can be seen in other forms of heart block as well (such as complete heart block).

OR 75

OR E-9-1-1 Coronary 75

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

The Skeptics' Guide to EM

DECEMBER 28, 2024

Exclusions: Patients unable to consent, non-English speakers, prisoners, acutely psychotic patients, critically ill patients, those suffering from dementia and those without a definitive diagnosis of OUD. Stigma in this context refers to the devaluation and discriminatory attitudes directed at individuals due to their condition.

Emergency Department 158

Emergency Department Overdose ED ALS 158

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 101

OR 101

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

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 129

OR STEMI Coronary Emergency Department 129

REBEL EM

FEBRUARY 15, 2024

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. Background: Patients with decreased level of consciousness due to alcohol, drugs, or medications commonly present to the ED.

ICU 141

ICU ALS ED OR 141

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). Alpha dominant: 7.9% Delta dominant 8.3% Omicron dominant: 8.4%

ALS 145

ALS OR EMS ED 145