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." Smith comment: But the tests (ECG and troponin) are extremely specific and so the post test probability is nearly 100%. Repeat cTnI drawn at around 8 AM was 3.910 ng/mL. This patient was not one of the lucky 6.4%

E-9-1-1 117

E-9-1-1 OR Coronary ACS 117

ALiEM

JANUARY 26, 2024

Ciprofloxacin has been documented as a cause of IgA vasculitis. The patient stated that she was started on Cipro eyedrops 1 or 2 days prior to presentation for a possible eye infection. It was not on her palms or soles. She had no mucous membrane involvement. They are somewhat raised, non-blanching, not itchy, and non-tender.

EMS 183

EMS OR 183

Dr. Smith's ECG Blog

SEPTEMBER 18, 2024

We documented that the majority of stenotic lesions had compensatory enlargement and thus exhibited remodeling. Strictly speaking — this case does not at this time qualify as MINOCA — because the negative cath and 2 normal hs-troponins done 6 hours apart failed to document infarction. (

Coronary 116

Coronary ACS OR EMR 116

Dr. Smith's ECG Blog

SEPTEMBER 22, 2023

And you can see why: the artery may sponstaneously reperfuse, as it did here well before angiography, and documented with resolution of pain and evolution of the ECG to typical full reperfusion pattern Peak troponin I was 8544 ng/L. This is diagnostic of full reperfusion.] 90% of normals have some STE in V2 and V3. Which 1 or 2 leads are KEY?

OR 124

OR STEMI Coronary 124

High Performance EMS

JUNE 20, 2024

The documentation that is inherent in such a process also facilitates the reporting for performance reviews. Emergency medical care in the field should not be simply the first rung of a ladder to other health care careers, but a profession where providers can earn a living wage commensurate with the hazards of the care they afford to others.

EMS 240

EMS First Responder Emergency Response OR 240

The Skeptics' Guide to EM

JULY 27, 2024

That document tells us “Before widespread implementation, CDRs should be compared to clinical judgement.” [3] A randomized control trial (RCT) done in the prehospital setting enrolled 2,698 patients. However, getting the right diagnosis is clearly important for our patients, and as good as we are, no clinician is perfect.

ICU 183

ICU ALS Ambulance OR 183

EMS 12-Lead

SEPTEMBER 8, 2024

Paramedics increase the current slowly over nearly 3 minutes to 100ma where a documented mechanical capture (pulse palpation site not specified) was noted. He has a past medical history of HTN, HLD, DM, seizures, and ESRD with a regular hemodialysis schedule (per family, he adheres to his schedule meticulously).

Paramedic 230

Paramedic EMT EMT EMS 230

Pediatric EM Morsels

JULY 28, 2023

A critical MORSEL is that every child you treat for DKA needs to have an initial thorough neuro exam including cranial nerves and then frequent neuro reassessments … and document it ( so your colleagues who take over care for the kid can know if there has been a change )! or serum bicarbonate between 5-10 mmol/ L Severe : venous pH < 7.1

E-9-1-1 246

E-9-1-1 ALS OR Critical Care 246

ALiEM

JANUARY 22, 2024

Fever was documented to be 102°F and was not associated with any chills or rigors. A 40-year-old male, tailor by occupation, was brought to the Emergency Department with complaints of high-grade fever for the past 11 days. Case Question: What clinical condition is associated with eschars?

Emergency Department 161

Emergency Department OR 161

ESO

JANUARY 31, 2024

According to a recent study from ESO , decontamination procedures were only documented in 82% of all working fires incidents, and out of those exposures, only 4% documented all on-scene decontamination procedures. This leaves significant of room for improvement. What can the industry do?

Firefighter 105

Firefighter OR 105

Pediatric EM Morsels

FEBRUARY 2, 2024

In one ED study, ALL cases of missed travel-related illness did not have a documented travel history in their ED note , whereas 90% of the identified travel-related illnesses had a provider documented travel history (Greenky 2022) Those who are visiting friends and relatives (VFR) are typically at highest risk.

E-9-1-1 161

E-9-1-1 ED OR Emergency Department 161

Handtevy

MARCH 28, 2019

The amazing part of this story is that it took more than 20 years for the scientific community to prove this theory to be correct and for other doctors to accept it as standard practice. This interesting piece of history defines the term neophobia, or the fear of something new. Are there are evolutionary reasons for neophobia?

OR 52

OR Paramedic 52

The Skeptics' Guide to EM

SEPTEMBER 14, 2024

These “allergies” are often poorly documented and could potentially be more accurately described as intolerance [1]. Background: Penicillin allergies are among the most reported drug allergies, with estimates suggesting that up to 10% of the US population claims to have a penicillin allergy. A pivotal study by Raja et al.

ICU 136

ICU Emergency Department ALS ED 136

EMDocs

OCTOBER 3, 2023

This is also where keeping up with documentation starts to slip. You’ll need to put the following tasks in a rank order list: new patient evaluations, dispositions, managing critical or potentially critical patients, results review, team huddle, running the board, calling consults, doing procedures, and documentation.

EMR 98

EMR EMS OR Emergency Department 98

NVFC

OCTOBER 22, 2024

Course attendees received an instructor guide, slides, an Emergency Response Guide (ERG), and a resource drive with dozens of forms and documents to assist in local hazmat response planning. Pipeline and Hazardous Materials Safety Administration. This is the NVFC’s second SPST grant.

First Responder 116

First Responder Emergency Response EMS OR 116

The Skeptics' Guide to EM

OCTOBER 28, 2017

Stevens and colleagues updated their review in 2016 and concluded “sucrose is effective for reducing procedural pain” and “no serious side effects or harms have been documented with this intervention”. That rant relied upon a Cochrane SRMA by Stevens B et al 2013 and a randomized clinical trail published in Pediatrics by Gray L et al 2015.

ALS 130

ALS Emergency Department OR ED 130

The Good, The Bad & The Ugly Paramedic

JULY 1, 2020

In Australia, for example, AHPRA’s Paramedicine Board describes paramedics as "practitioners" throughout documentation regarding registration. As paramedics, whilst we often take great offence at being called ambulance drivers, the question is, when it’s our turn to drive, what exactly is it that we are providing?

Ambulance Driver 52

Ambulance Driver Paramedic Ambulance OR 52

The Skeptics' Guide to EM

JANUARY 23, 2021

The American College of Emergency Physicians ( ACEP ) also has a number of documents discussing APPs in the ED. AEM January 2021 Case: A 50-year-old male presents to the Emergency Department (ED) with left lower quadrant abdominal pain. The patient is seen by an advanced practice provider (APP).

ED 130

ED ALS Emergency Department OR 130

EMDocs

JULY 25, 2024

The nurse completes the Columbia-Suicide Severity Rating Scale (C-SSRS) and documents that the patient’s recent thoughts of killing himself and his detailed plan makes him “High Risk” for suicide. There is no documented handoff to the on-coming emergency physician (EP) who assumes care. ” 0700 : The PA-C goes off-shift.

ED 82

ED ALS Emergency Department OR 82

EMDocs

MAY 9, 2024

Exam documents that he is alert and oriented but “tired appearing” and “not appearing post-ictal.” Defense : The EP did address the seizure when he documented “not post-ictal.” There is no negligence, as the documentation supports reasonable judgment. The triage nurse records the event as a “seizure” lasting 7 minutes.

ED 83

ED EMS OR 83

NAEMSP

APRIL 15, 2024

All cases with restraints should be clearly documented, in some systems medical control should be involved, QA of all these cases should be considered. Article Summary by Sarah Fabiano, MD, FACEP, FAAEM Kupas DF, Wydro GC, Tan DK, Kamin R, Harrell AJ 4th, Wang A. Prehosp Emerg Care 2021 Sep-Oct;25(5):721-3. doi: 10.1080/10903127.2021.1917736.

OR 52

OR Emergency Medical Technician Emergency Medical Services EMS 52

Pediatric EM Morsels

JULY 5, 2024

It seems like just yesterday ( or maybe ~ a month ago ) when we served up a tasty morsel on the PECARN decision rule for intra-abdominal traumatic injuries in children. Our friends at the PECARN injury group have remained busy this spring with generating more externally validated clinical decision rules. High Risk (12.8% High Risk (12.8%

ALS 161

ALS OR ED Emergency Department 161

ALiEM

MARCH 11, 2024

There is limited literature documenting eye involvement and pictographic examples of its presentation. He also noticed fluid-filled vesicles on his face, neck, trunk, and extremities. He denied travel outside the U.S. but reported a recent trip to New Orleans. Additional Images Physical Exam Vitals : BP 135/83; Pulse 104; Temp 100.2 °F

Emergency Department 141

Emergency Department ALS OR 141

REBEL EM

MAY 15, 2023

Frantically look through the assisted care documents for do-not-resuscitate paperwork Place a chest tube on the left side Place a chest tube on the right side Start noninvasive or mechanical ventilation FOR THE RIGHT ANSWER CLICK ON THE ROSH REVIEW LOGO BELOW References: Dixon A. Mucous plug with left lung collapse.

EMS 98

EMS Ambulance ED OR 98

The Curious Clinicians

OCTOBER 2, 2024

Sponsor Freed is an AI scribe that listens, transcribes, and writes medical documentation for you. It turns clinicians’ patient conversations into accurate documentation – instantly. Some of these cascades, even if cumbersome to the patient, make a certain amount of physiological sense. However, one cascade is a little less obvious.

ACS 105

ACS ALS OR 105

ACEP Now

OCTOBER 3, 2023

This document is an update of guidelines first published in 2000, and then updated in 2007. Confounders to the GCS such as seizure and post-ictal phase, ingestions and drug overdose, as well as medications administered in the prehospital setting that impact GCS score should be documented.

Emergency Medical Services 98

Emergency Medical Services EMS OR Overdose 98

The Skeptics' Guide to EM

NOVEMBER 21, 2020

The American College of Emergency Physicians ( ACEP ) has a number of documents discussing APPs in the ED. Case: You are the medical director of a medium sized urban emergency department (ED). Volumes have increased over the past few years and you’re considering adding an extra shift or two.

Emergency Department 130

Emergency Department ALS ED OR 130

The Skeptics' Guide to EM

JANUARY 16, 2021

The first documented use of topical ophthalmologic anesthetics was in 1818. Case: A 32-year-old healthy man presents with left eye pain. He was giving his 9-month-old a hug and got poked in the eye with a sharp little fingernail. His visual acuity is 20/20 bilaterally and he doesn’t wear corrective lenses or contact lenses.

ALS 130

ALS Emergency Department EMS ED 130

Chicago EMT Training

JANUARY 5, 2023

Out of all the things, becoming an EMT really unveiled what healthcare might truly have in store for me. We look forward to working with you.

EMT 130

EMT EMT Allergic Reaction CPR 130

EMT Training Station

FEBRUARY 11, 2024

Hidden Dangers and Visible Clues Unlike thermal burns, electrical burns can cause significant internal damage while leaving minimal external signs. The entry and exit wounds are key indicators, but they can be small or hidden under clothing. As first responders, we’re trained to look for these subtle clues.

EMT 98

EMT EMT Emergency Medical Technician First Aid 98

EM Literature of Note

OCTOBER 9, 2024

while also relying upon finished human documentation for its “decision-support” The prompts – “should”/”does” – replicate the intent of the decision-support concept of the exploration, but not the retrospective nature of the content. ” or “ did this patient receive antibiotics?”

Emergency Department 84

Emergency Department OR ED 84

REBEL EM

JUNE 22, 2023

Population: Adults aged 30-85 years of age with BMI > 25 ( > 23 in those identifying as Asian or Latino) who had COVID-19 symptoms for fewer than 7 days and a documented SARS-CoV-2 positive PCR or antigen test within 3 days of enrollment without prior SARS-CoV-2 infection. Alpha dominant: 7.9% Delta dominant 8.3%

ALS 145

ALS OR EMS ED 145

The Skeptics' Guide to EM

OCTOBER 1, 2022

It is not well documented, whether gaps in pain assessment and treatment exist in conditions in which opioids are not indicated, such as migraine headaches. Case: A 15-year-old patient presents to the Emergency Department with a unilateral pounding headache. The headache is similar to prior migraine headaches.

Emergency Department 130

Emergency Department ALS ED OR 130

Dr. Smith's ECG Blog

SEPTEMBER 9, 2024

The operator documented thoughtful consideration of risks and benefits of stent placement. In a large proportion of cath labs, the operator would probably have ended the case at this point. Smith comment : a very high proportion of MINOCA are ruptured plaque with lysed thrombus. That plaque is at risk of thrombosing again.

OR 70

OR Coronary ACS EMS 70

NCOAE

DECEMBER 11, 2023

The NAEMSP position paper and supporting resource document states that a patient with neurologic deficit and spinal pain or tenderness may be placed on an LSB, but the LSB should be considered an extrication device only, with the patient being removed from the LSB as soon as possible. to prevent movement of the spine.

OR 52

OR Emergency Medical Technician Emergency Department Emergency Medical Services 52

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-9-1-1 118

E-9-1-1 ACS OR Emergency Department 118

EMDocs

AUGUST 22, 2024

13 Interventions may include: Ascertaining a patient’s preferred language early in the clinical encounter (during registration, for instance), and clearly documenting this preference in a place that is visible to all providers. Utilizing certified interpreters and documenting their use. Educating patients on their rights.

Emergency Department 82

Emergency Department ALS E-9-1-1 ED 82