EMDocs

SEPTEMBER 23, 2023

Answer : Brugada Syndrome Epidemiology and Etiology Rare genetic disorder that affects approximately 1 in 5,000 individuals worldwide 1. More common in males than females, with a male-to-female ratio of approximately 8:1 1. Type 1 “Brugada sign” The only type that is considered diagnostic.

E-9-1-1 83

E-9-1-1 EMS ALS Defibrillator 83

Dr. Smith's ECG Blog

JULY 22, 2023

A prior ECG from 1 month ago was available: The presentation ECG was interpreted as STEMI and the patient was transferred emergently to the nearest PCI center. Patients that develop a Type 1 pattern without any precipitating or provoking factors have a risk of SCD of 0.5-0.8% He denied chest pain or shortness of breath.

E-9-1-1 70

E-9-1-1 CAD OR STEMI 70

REBEL EM

NOVEMBER 30, 2023

Article: Vaeli Zadeh A, Wong A, Crawford AC, Collado E, Larned JM. Guideline-based and restricted fluid resuscitation strategy in sepsis patients with heart failure: A systematic review and meta-analysis [published online ahead of print, 2023 Aug 9]. Am J Emerg Med. 2023;73:34-39. Results: 26,069 studies met initial inclusion criteria.

E-9-1-1 122

E-9-1-1 ALS ACS ICU 122

Dr. Smith's ECG Blog

JUNE 17, 2024

Pain improved to 1/10 after EMS administers 324 mg aspirin and the following EKG is obtained at triage. C Examination notable for diaphoresis, 1+ bilateral lower extremity edema, regular heart rate and rhythm, and no signs of respiratory distress with normal breath sounds. What do you think? In fact, Kosuge et al. Stein et al.

E-9-1-1 137

E-9-1-1 ACS Emergency Department Coronary 137

Pediatric EM Morsels

MAY 5, 2023

2018 Dec 20;11(1):5. Hovinen T, Korkalo L, Freese R, Skaffari E, Isohanni P, Niemi M, Nevalainen J, Gylling H, Zamboni N, Erkkola M, Suomalainen A. Lemale J, Mas E, Jung C, Bellaiche M, Tounian P; French-speaking Pediatric Hepatology, Gastroenterology and Nutrition Group (GFHGNP). Supplementation is key! 2021 May 18;13(5):1707.

E-9-1-1 130

E-9-1-1 OR EMS 130

FOAMfrat

APRIL 22, 2024

This kid had sticks go through his cheek from running with a lollipop, hit by a car, almost kidnapped, attacked by a dog, and almost burnt his house down by throwing a 9-volt battery in the trash. Simulation allows EMS clinicians to train for scenarios they may encounter in the field.

E-9-1-1 78

E-9-1-1 ACS Paramedic Critical Care 78

Pediatric EM Morsels

AUGUST 18, 2023

Myth #1: Musculoskeletal Adverse Events (MAE) This concern is likely the most common reason fluoroquinolones are rarely used in children. Which is a risk of 1 event for 62.5 None of the patients were documented to have joint disease at follow up. Fluoroquinolone Use in Children: A Bad Rep? There were 2523 children included.

E-9-1-1 130

E-9-1-1 OR ACS ALS 130

REBEL EM

JULY 3, 2023

Pregnant or incarcerated patients Documentation for systolic BP is incomplete Intervention: Administration of IV calcium within 60 min prior to or 30 min after IV diltiazem administration in patients with AF/AFL with RVR. The study was dependent on EMR documentation which is prone to error.

E-9-1-1 98

E-9-1-1 EMR Emergency Department ED 98

Don't Forget the Bubbles

MAY 6, 2024

Article 1: Positive urine cultures without pyuria Wang ME, Jones VG, Kane M, et al. Article 1: Positive urine cultures without pyuria Wang ME, Jones VG, Kane M, et al. Clinical Course of Children 1 to 24 Months Old With Positive Urine Cultures Without Pyuria. 2024;24(1):111-118. Acad Pediatr. doi:10.1016/j.acap.2023.06.023

E-9-1-1 75

E-9-1-1 Emergency Department OR ALS 75

EMDocs

AUGUST 22, 2024

1 However, we recognize that many patients prefer to speak a language other than English regardless of their English proficiency, and this does not indicate a deficiency. 9 Less likely to be satisfied with their care and have a lower understanding of their discharge instructions. 11 Unlikely to receive language assistance.

Emergency Department 81

Emergency Department ALS E-9-1-1 ED 81

Don't Forget the Bubbles

FEBRUARY 26, 2024

Add in PEFR <33% and SpO2 <92% Management of acute asthma* * as per BTS guidelines Acute asthma is managed in a stepwise fashion using the following guidelines. Intubation, however, can be a significant challenge in these patients.

E-9-1-1 72

E-9-1-1 Critical Care OR ALS 72

Dr. Smith's ECG Blog

JUNE 30, 2023

Queen: #1: NOT OMI, HIGH CONFIDENCE Queen: #2: NOT OMI, HIGH CONFIDENCE ECG 1 Interpretation: there is terminal T-wave in V3-V6. LEARNING POINT : 1. Smith and Meyers containing thousands of tracings with documentation of cardiac catheterization results. in ECG #1 ). These were texted to me only with "chest pain."

E-9-1-1 52

E-9-1-1 Coronary ED OR 52

Don't Forget the Bubbles

MARCH 11, 2024

Terminology Plagios is ancient Greek for oblique or slanting Cephal is Latin for head or skull. When put together as ‘plagiocephaly’, the term broadly means cranial asymmetry. Deformational plagiocephaly is due to external forces causing constraint or twisting. Possible causes include twin pregnancy, intra-uterine constraint, or sleeping position.

E-9-1-1 59

E-9-1-1 OR ED 59

REBEL EM

SEPTEMBER 26, 2022

2020;71(1):235-246. Article: Kumar M et al. Thromboelastography-Guided Blood Component Use in Patients With Cirrhosis With Nonvariceal Bleeding: A Randomized Controlled Trial. Hepatology. Significant coagulopathy: INR > 1.8 Significant coagulopathy: INR > 1.8 Significant coagulopathy: INR > 1.8

FFP 52

FFP E-9-1-1 ICU ALS 52

Dr. Smith's ECG Blog

SEPTEMBER 10, 2023

Ongoing pain noted throughout all documentation, but after nitro drip and prn morphine, "pain improved to 2/10." References: 1) See this study showing an association between morphine and mortality in Non-STE-ACS: Meine TJ, Roe M, Chen A, Patel M, Washam J, Ohman E, Peacock W, Pollack C, Gibler W, Peterson E.

E-9-1-1 78

E-9-1-1 ACS STEMI Coronary 78

NAEMSP

JANUARY 5, 2023

1] The Adult Cardiac Arrest ACLS algorithm currently includes epinephrine and either amiodarone or lidocaine as recommended pharmacologic therapies. 1] Table from Hamam et al. 9] Figure from Clemency et al. Or in other words, is IO access inferior to IV access? Below, we will examine the current literature.

E-9-1-1 52

E-9-1-1 Advanced Life Support Epinephrine Life Support 52

ACEP Now

FEBRUARY 11, 2024

Gently inject 1 to 2 cc of anesthetic to hydrodissect the clavipectoral fascia from the clavicle. Every year, approximately 332,000 people in the United States suffer from a clavicular fracture. 1,2 The mainstay of pain control in the ED has been either oral or intravenous non-steroidal anti-inflammatory drugs (NSAIDs) or opioids.

E-9-1-1 52

E-9-1-1 ALS ED Emergency Department 52

Don't Forget the Bubbles

DECEMBER 13, 2023

It is commonly seen in the first couple of years of life and accounts for 1-5% of paediatric hospital admissions for those under two. Failure to thrive’ has many definitions We use standardized charts to document infant growth. E.g. cleft palat e. ‘failure to thrive’, describes a slow growth pattern.

E-9-1-1 98

E-9-1-1 OR 98

Don't Forget the Bubbles

JULY 5, 2023

Figure 1: Clinical manifestations and long-term consequences of sickle cell disease Training and education on sickle cell disease: Training and education are crucial to improve morbidity and mortality. Investigations : Bloods show Hb of 8 g/L, White cell count 13x 10 9 /L, Platelets 570 x10 9 /L, CRP 35mg/L.

E-9-1-1 126

E-9-1-1 ACS OR ICU 126

Dr. Smith's ECG Blog

FEBRUARY 28, 2020

4 important features that indicate acute right hear strain: 1. In this study, (quote) "negative T waves in leads III and V 1 were observed in only 1% of patients with ACS compared with 88% of patients with APE (p less than 0.001). They found that only 11% of PE had 1 mm T-wave inversions in both lead III and lead V1, vs. 4.6%

E-9-1-1 52

E-9-1-1 ACS ALS OR 52

Dr. Smith's ECG Blog

JANUARY 30, 2019

The pattern of STE and STD reminded us of Brugada Type 1 morphology. Smith comment: 1) Brugada ECG may have ST shifts in limb leads as well as precordial leads. Patients that develop a Type 1 pattern without any precipitating or provoking factors have a risk of SCD of 0.5-0.8% The article is edited by Smith. F (rectal).

E-9-1-1 52

E-9-1-1 CAD STEMI OR 52

REBEL EM

OCTOBER 5, 2023

1-6 We now have the Community-Acquired Pneumonia: Evaluation of Corticosteroids (CAPE COD) Trial. Patients admitted to the ICU with severe community-acquired pneumonia were randomized in a 1:1 ratio to receive hydrocortisone or a placebo. However, except for one trial, none showed a between-group difference regarding mortality.

Critical Care 94

Critical Care ICU E-9-1-1 ALS 94

Dr. Smith's ECG Blog

NOVEMBER 28, 2022

Right atrial diastolic collapse is the earliest sign, but the patient needs to have right atrial collapse for at least 1/3 of the cardiac cycle which can be difficult to identify with ultrasound. Beck’s triad only happens all 3 together in approximately 1/3rd of patients. 2013 Sep;26(9):965-1012.e15. J Am Soc Echocardiogr.

E-9-1-1 52

E-9-1-1 OR ED Emergency Department 52

Dr. Smith's ECG Blog

JANUARY 5, 2020

There are 5 other rhythms that are irregularly irregular , though atrial fibrillation is by far the most common: 1. See below how this has been documented. However, incorrect automated and physician overread interpretations are common and have been shown to adversely affect patient management [ 1 ]. Sinus with multifocal PACs 3.

E-9-1-1 52

E-9-1-1 ALS OR 52

EMDocs

JANUARY 11, 2024

The neurologic section was divided into (1) brain oxygenation, perfusion, edema, and intracranial pressure (ICP); (2) seizures and the ictal-interictal continuum (IIC); and (3) sedation and analgesia. Each small group identified topics, and then the topics were voted on by the entire panel. Instead, target 92-98%.

Critical Care 75

Critical Care E-9-1-1 OR ICU 75

EMDocs

NOVEMBER 16, 2024

1-3 Despite its commonality it retains a relatively high rate of complications overall and patients frequently present to the ED for evaluation. 9=11 70% monomicrobial, 25% poly-microbial, 5% culture-negative. 9=11 70% monomicrobial, 25% poly-microbial, 5% culture-negative. 8 Perform and document distal neurovascular exam.

EMS 75

EMS E-9-1-1 Operating Room Emergency Department 75

EMDocs

FEBRUARY 12, 2024

Introduction Arterial blood gas (ABG) or venous blood gas (VBG) testing is used to assess the pH and systemic carbon dioxide tension in patients, and, therefore, provide a more complete picture of their acid-base status than an isolated basic metabolic panel (BMP) (1). What alternative testing can be done in these circumstances?

Emergency Department 94

Emergency Department E-9-1-1 ED ICU 94

ACEP Now

OCTOBER 29, 2024

EMS found the patient pulseless and apneic, with an initial rhythm showing ventricular fibrillation (see figure 1). Figure 1: The EMS rhythm strip. Type 1 is diagnostic and characterized by J point and ST elevation > 2 mV with coved ST- elevation in at least two precordial leads, followed by negative T wave.

E-9-1-1 52

E-9-1-1 Defibrillator ALS Epinephrine 52

EMDocs

JULY 3, 2023

This neurological evaluation should include assessment and documentation of the GCS, the presence of any neurologic deficits, and an NIHSS. Presentation Traumatic SAH occurs following a direct or indirect traumatic mechanism leading to TBI that allows for bleeding into the subarachnoid space.

ED 85

ED E-9-1-1 ALS OR 85

ACEP Now

OCTOBER 9, 2023

Physicians should document the interpreter’s name and identification number if available in the patient’s chart. Clinical Case Your next patient is a Spanish-speaking 24-year-old female who begins by telling you that she is embarazada. Census Bureau, 60.6 million Americans (approximately 20.8 emergencies, patient’s request).

Emergency Department 64

Emergency Department E-9-1-1 ALS OR 64

AAEM RSA

DECEMBER 3, 2020

Introduction: While cases of genital gangrene were documented as early as 980 CE, the condition we know today as FG was coined in the 1880’s by French venerologist, Jean Alfred Fournier. Diagnosis is clinical and challenged by overlap with more superficial skin infections (i.e.

Emergency Department 52

Emergency Department E-9-1-1 ALS EMT 52

Don't Forget the Bubbles

AUGUST 10, 2023

Descriptive Terms When describing injuries of the hand for documentation or referral purposes it is important to know the terminology that is widely in use in order to convey an accurate description to others. Topic Hand Examination and Pathology Author Segn Nedd Duration 2.5 Injuries on the back of the hand are dorsal.

E-9-1-1 52

E-9-1-1 Emergency Department OR ED 52

AAEM RSA

SEPTEMBER 17, 2020

Thiamine also plays a role in key metabolic processes, including cellular energy production and generation of cellular antioxidants, and thiamine deficiency has been well-documented in sepsis, with observational studies indicating a signal for improved outcomes with supplementation. Keh D, Trips E, Marx G, et al. 2016:316(17);1775-85.

ICU 52

ICU E-9-1-1 ALS OR 52

REBEL EM

NOVEMBER 11, 2024

What They Did: Investigators performed a retrospective cohort study in the Emergency Department at the University of Michigan between July 1, 2014 through December 31, 2018. 2 Vancomycin, in combination with either piperacillin-tazobactam or cefepime, is commonly used for empiric treatment in these cases. In 2021, Buckley et.

E-9-1-1 84

E-9-1-1 ALS ICU Critical Care 84

Don't Forget the Bubbles

NOVEMBER 5, 2023

Xylitol for the prevention of acute otitis media episodes in children aged 1-5 years: a randomised controlled trial. Parental physical disease severity and severe documented physical child abuse: a prospective cohort study. 2023 Oct 9. 2023 Oct 9. Soydan E, et al. Harstad E, et al. 2023 Oct 1.

E-9-1-1 105

E-9-1-1 ALS Emergency Department OR 105

Dr. Smith's ECG Blog

APRIL 8, 2015

Cardiac Syncope ("True Syncope") Independent Predictors of Adverse Outcomes condensed from multiple studies 1. Summary of ED Approach to Syncope Please excuse the formatting problems, which I have not been able to fix! I have used this to educate our residents, and I think they find it useful. It is NOT a structured review or meta-analysis.

Emergency Department 52

Emergency Department E-9-1-1 ED OR 52