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.

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E-9-1-1 ACS Emergency Department Coronary 139

Don't Forget the Bubbles

JUNE 30, 2023

He has already climbed Ben Nevis in Scotland, visited the Gobi desert (possibly from the comfort of his parents 4 x 4, but who’s judging) and has his bronze D of E nailed. She calls out her findings: A – OK B – 1 puncture mark to the anterior left chest wall, covered with a three-sided dressing. Actively oozing.

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E-9-1-1 FFP Plasma Emergency Department 139

EMS 12-Lead

AUGUST 22, 2022

A 65 y/o Female was admitted to the ICU for septic shock. Question 1: What is the rhythm? Beat 1 : Sinus, narrow QRS complex. The assumption is that a premature complex discharged prior to Beat 1, which prolonged its respective refractory period in the same manner as Beat 5.

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E-9-1-1 Coronary ALS ICU 130

REBEL EM

OCTOBER 5, 2023

1-6 We now have the Community-Acquired Pneumonia: Evaluation of Corticosteroids (CAPE COD) Trial. ClinicalTrials.gov: NCT02517489 7 Clinical Question: In adult patients with severe community-acquired pneumonia admitted to the ICU, does early hydrocortisone treatment, compared to standard therapy, reduce mortality at 28 days?

Critical Care 94

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

EMDocs

FEBRUARY 26, 2024

Authors: Kamoga Dickson, MD (EM Resident Physician, Makerere University of Health Sciences); Jessica Pelletier, DO (EM Education Fellow, Washington University in St. They attach to type 1 pneumocytes, resulting in diffuse alveolar damage through the erosion of these pneumocytes. for detecting pulmonary opacities.

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E-9-1-1 ED ALS OR 110

Don't Forget the Bubbles

AUGUST 28, 2023

You contact ICU, anaesthetics, ENT, and oncology with a plan to attempt more definitive imaging in the prone position (which Ginny tells you is much comfier) What’s the evidence for our emergent management? The median age at diagnosis was 47 months (range 1-173 months). 2014;9(9):S102-S109. 2019;43(1):98-103.doi:10.1097/RCT.0000000000000782

Emergency Management 97

Emergency Management Emergency Manager E-9-1-1 Critical Care 97

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

Broome Docs

OCTOBER 31, 2022

Ketamine vs etomidate in ICU intubation ? 2022 Jan;48(1):78-91. PMID: 34904190 Not surprisingly, this paper has been covered by basically everyone who talks about research, so if you want to hear some other opinions, check out the SGEM , REBEL EM , or St. 2022 Sep;21(9):781-791. Intensive Care Med. Epub 2021 Dec 14.

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E-9-1-1 Defibrillator ICU Critical Care 52

REBEL EM

AUGUST 21, 2023

This trial aimed to assess whether targeted therapeutic mild hypercapnia (TTMH) applied during the initial 24 hours of mechanical ventilation in the ICU can enhance neurological outcomes at the 6-month mark, as compared to standard care, which involves targeted normocapnia (TN). Paper: Eastwood G, et al. Resuscitation. Epub 2021 Feb 8.

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E-9-1-1 Critical Care CPR ALS 92

REBEL EM

MAY 8, 2023

Paper: Smith JA, Secombe P, Aromataris E. Only 1 RCT and 1 cohort study had only mechanically ventilated patients. References: Smith JA, Secombe P, Aromataris E. appeared first on REBEL EM - Emergency Medicine Blog. The pendulum is swinging towards conservative management for occult pneumothoraces. PMID: 34225346.

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Dr. Smith's ECG Blog

MAY 5, 2022

Submitted and written by Destiny Folk MD , peer reviewed by Meyers, Smith, Grauer, McLaren A man in his early 30s with no significant past medical history was brought to the ED by EMS after being found unresponsive by a friend. EMS arrived and found him awake and alert. Figure-1: I've reproduced the initial ECG in today's case.

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E-9-1-1 OR STEMI ED 52

ACEP Now

NOVEMBER 14, 2023

1 However, it is important to understand that death from hemoptysis is almost always due to hypoxia or asphyxiation (blood impedes gas exchange in the lungs, typically because of bleeding from high-pressure bronchial arteries into the lungs) as opposed to hemodynamic instability. These patients are at imminent risk of respiratory failure.

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

ALiEM

OCTOBER 30, 2024

Due in large part to the proliferation of anonymous chemical factories able to produce industrial volumes of inexpensive synthetic opioids without opium or other controlled precursors, fentanyl spilled into the United States, Canada, and Europe, heroin soon fell to market forces [1, 2]. Xylazine withdrawal is controversial.

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E-9-1-1 Naloxone Emergency Department ALS 161

EMDocs

OCTOBER 7, 2023

We’ll keep it short, while you keep that EM brain sharp. A 17-year-old girl, in moderate distress, is brought in by EMS after a motor vehicle collision. EMS reports that she was “pinned” underneath the dashboard, and it took several hours to extricate her.

EMS 97

EMS E-9-1-1 Emergency Department ALS 97

EMDocs

JANUARY 6, 2024

Authors: Christian Gerhart, MD (EM Resident Physician, Washington University School of Medicine, St. Louis, MO); Jessica Pelletier, DO (EM Education Fellow, Washington University School of Medicine, St. We’ll keep it short, while you keep that EM brain sharp. A 64-year-old male presents by EMS to the ED with shortness of breath.

EMS 88

EMS E-9-1-1 ACS Coronary 88

EMDocs

FEBRUARY 12, 2024

Authors: Rachel Kelly, MD ( EM Resident Physician, Stony Brook University Hospital); Robert Nocito, MD (EM Attending Physician, Stony Brook University Hospital) // Reviewed by: Jessica Pelletier, DO (EM Education Fellow, Washington University in St. However, ABGs have many drawbacks compared to VBGs.

Emergency Department 98

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

EMDocs

DECEMBER 18, 2023

Today, she would not get out of bed, prompting the facility to call EMS. This was based on studies that demonstrated qSOFA was more specific but less sensitive than its counterparts (Table 1). These include C-reactive protein, procalcitonin, interleukin-6, CD64, presepsin, and sTREM-1. She had a fever of 38.7 °C

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E-9-1-1 ALS Emergency Department Plasma 91

EMDocs

JUNE 27, 2024

Abdomen : ND, NT, no guarding or rebound MSK : Tenderness to palpation over L ribs 7-9 Derm : No rashes Imaging: Image 1: Case courtesy of Miriam Leiderer, Radiopaedia.org, rID: 81468 Chest radiograph (CXR) shows new left lower lobe opacity What’s most likely diagnosis? C or 100.4 mg/kg, max 0.4 C or 100.4 mg/kg, max 0.4

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E-9-1-1 ICU ACS EMS 97

REBEL EM

NOVEMBER 11, 2024

4 The 2023 ACORN Trial ( covered here on REBEL EM ) randomized 2,511 patients requiring antipseudomonal coverage to receive either cefepime or piperacillin-tazobactam. 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.

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E-9-1-1 ICU ALS Critical Care 101

EMDocs

JUNE 7, 2023

1-5 Farmers also treat sheep for parasites using OPs and may become symptomatic after exposure, an illness called Dipper’s Flu. 8 Intermediate syndrome Occurs 1 to 5 days after acute exposure in up to 40% on individuals. 7, 9 Often have absence of excessive cholinergic stimulation. 7 May lead to respiratory failure.

E-9-1-1 98

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

EMDocs

OCTOBER 29, 2024

Authors: Rachel Bridwell, MD (EM Attending Physician; Tacoma, WA), Katey DG Osborne, MD (EM Attending Physician; Tacoma, WA) // Reviewed by: Alex Koyfman, MD (@EMHighAK, EM Attending Physician, UTSW / Parkland Memorial Hospital) and Brit Long, MD (@long_brit, EM Attending Physician, San Antonio, TX) Welcome to emDOCs revamp!

E-9-1-1 98

E-9-1-1 ICU Epinephrine EMS 98

EMDocs

FEBRUARY 8, 2025

Well keep it short, while you keep that EM brain sharp. He reported having a COVID-19 infection 3 weeks ago but felt better 1-2 weeks ago. 1 WHO Critical Priority Fungal Pathogens Cryptococcus neoformans Globally distributed, found in soil/wood/trees 1 C. Four days ago, he presented to the ED for a COPD exacerbation.

ED 72

ED E-9-1-1 EMS ICU 72

EMDocs

DECEMBER 6, 2024

1 The incidence of iron overdose and iron ingestion related deaths has significantly decreased over time, likely attributable to federal regulation. 1 Commercially available formulations of iron have varying elemental components. 1 Table 1: Iron content of various preparations. Be wary of this stage.

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E-9-1-1 Frozen Plasma Plasma Overdose 97

FOAMfrat

NOVEMBER 28, 2024

That said, complications tied directly to intubation in the field—like aspiration—tend to be more common due to the conditions EMS providers work under compared to the controlled environment of a hospital. "I’d say that EMS providers already do a phenomenal job managing complex airways in challenging conditions. Why is that? "Ketamine

E-9-1-1 52

E-9-1-1 Critical Care ICU EMS 52

Core EM

JANUARY 16, 2025

An EM Residents Guide to Basic Airway Management Authors: Justin Rice, MD Sagar Desai, MD Eunice Monge, MD William Chiang, MD Preface: Airway management is one of the most critical skills in emergency medicine, yet it can be one of the most challenging to master. Introduction Airway management is a critical ED skill to master.

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E-9-1-1 EMS ALS OR 130

EMDocs

JANUARY 6, 2025

ED Evaluation Transport to the ED from the refugee reception center takes 1 hour. g/dL, thrombocytopenia of 96 10 9 /L, prothrombin time (PT) of 16.1 1 By the end of 2023, 117.3 million people had been forcibly displaced, representing 1 in 69 individuals or 1.5% seconds (normal 30-40 seconds), creatinine of 3.11

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