Dr. Smith's ECG Blog

DECEMBER 11, 2023

Moreover , the patient has ongoing symptoms and has an unexplained elevated troponin, so she is having an MI and the only question is whether it is type 1 or type 2 due to hypertension. Case continued She was loaded with aspirin 325 mg, and repeat troponin drawn around the time of EKG 1 resulted at 267 ng/L. At midnight. At midnight.

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EMDocs

MARCH 2, 2024

Answer : Pneumocephalus 1-21 Background: Pneumocephalus is defined by the presence of air within the cranial cavity. 1-3] The most common location is the frontal region, followed by the occipital and temporal regions. [4] 1-3] The most common location is the frontal region, followed by the occipital and temporal regions. [4]

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Dr. Smith's ECG Blog

NOVEMBER 14, 2023

Learning Point: 1. link] = My Comment by K EN G RAUER, MD ( 11/14 /2023 ): = One of the most helpful clinical clues in support that an acute cardiac event is ongoing — is the finding of " dynamic " ECG changes. No wall motion abnormality identified. Normal LV cavity size with moderately increased wall thickness.

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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? Other lung fields unremarkable. C or 100.4 mg/kg, max 0.4

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EMDocs

JANUARY 17, 2024

1) There are a limited number of antitussives on the US market which include benzonatate, codeine, dextromethorphan, diphenhydramine, and hydrocodone. 3, 7) The accumulating post marketing adverse event reports led to the FDA release of a Drug Safety Communication (DSC) in 2010, over 50 years after initial approval. (9)

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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.

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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

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EMDocs

APRIL 10, 2024

1-5] Since then, many more medications have been developed and deployed. 1-5] This post focuses on the identification and management of Local Anesthetic Systemic Toxicity (LAST). 3-5,7] Symptom onset is usually within 1 minute of intravascular injection but can be delayed if multiple injections or continuous infusion. [5]

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Don't Forget the Bubbles

OCTOBER 4, 2023

The NEJM published the PREDICT trial, concluding that prophylaxis is ‘statistically’ effective in preventing the first UTI in neonates (albeit a small effect, and it comes at the cost of an increased occurrence of non– E coli organisms and antibiotic resistance). 2023 Sep 1:113720. 2023 Sep 1:113717. 2023 Sep 1:e2023062521.

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Don't Forget the Bubbles

NOVEMBER 22, 2023

Of these signs, mortality in children is associated with hepatomegaly and fever; meanwhile, mortality in adults is associated with hyperkalaemia, traumatic brain injury, propofol infusion rates >5mg kg -1 h -1 and ECG changes. 1998;8(6):491-9. What are the clinical features of PRIS? Why does PRIS occur? References Bray RJ.

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ACEP Now

JANUARY 14, 2024

1-3 We may be unaware of potentially dangerous drug interactions when we order and prescribe medications in the ED. Many common presentations to the emergency department (ED) are related to drug interactions that are commonly missed and largely preventable. The resulting morbidity and mortality is significant.

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Don't Forget the Bubbles

JUNE 30, 2023

E – Temp 37.2 Survival was better, both at 24 hours and six months, in the TXA group, although the primary outcome, a quality of life score at six months, called the Glasgow Outcome Scale Extended (GOS-E), was the same in both groups ( 53.7% Pupils are equal and reactive. This is not good. This is not good. This is not good.

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EMDocs

MARCH 30, 2024

Comprehensive physical exam is unremarkable, but she does have pain at the T-12/L-1 region of her back. Her patellar reflexes are 1+ bilaterally, no ankle clonus is noted, and she denies any saddle anesthesia or bowel/bladder incontinence. CT of lower spine is ordered and shows the following: 1 What is the diagnosis?

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ACEP Now

JANUARY 9, 2024

FIGURE 1: Abdominal X-ray showing particulate radiopaque foreign bodies involving the stool. 1 Children are particularly vulnerable. 9 Lead exerts its toxic effects by interfering with various organ functions, primarily targeting the nervous system and hematopoietic system, as well as impairing liver and kidney functions.

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Dr. Smith's ECG Blog

MAY 5, 2023

. = Dr. Smith was reading ECGs — and he sent myself and Dr. Meyers the tracing shown in Figure-1. Figure-1: The initial ECG in today's case. Our Initial Thoughts on the ECG in Figure-1: Dr. Meyers said the following: "I see 2 different atrial foci — one sinus and one ectopic. At the time we did not yet know the history.

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EMDocs

MAY 11, 2024

CT head without contrast 1 is performed and reveals the following: Question: What is the diagnosis? On exam, the patient opens eyes to voice, has extraocular movements intact, is unable to speak, and has 0/5 strength in all extremities. The patient was intubated for acute hypercapnic and hypoxic respiratory failure and airway protection.

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ACEP Now

JULY 7, 2024

My interview by the male emergency physician was painfully brief, but I was forthright about being from the same specialty, explained in detail the preceding events, and said that I understood that he wanted to rely on a formal psychiatric evaluation before deciding if I was safe to be discharged to home.

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EMS 12-Lead

AUGUST 22, 2022

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. A 12 Lead ECG was recorded secondary to bizarre telemetry findings at bedside. Said differently, it’s a mess.

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Dr. Smith's ECG Blog

NOVEMBER 15, 2023

Post cath ECG: Now there are hyperacute T-waves again, and recurrent ST depression in V2 This ECG would normally diagnostic of OMI until proven otherwise No further troponins were measured, but it looks like there is recurrent OMI Next day: A CT Coronary Angiogram was done (CTCA) CARDIAC MORPHOLOGY AND FUNCTION: 1. IMPRESSION: 1.

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Don't Forget the Bubbles

JANUARY 17, 2024

The vast majority were managed at home, with no adverse events reported. Around 80% of those reported pass spontaneously, with another 10-20% requiring endoscopic removal and only 1% requiring surgical intervention. Roy was less than impressed when young Kendall tried to eat his Orbeez. Here, a water bead had been aspirated.

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Dr. Smith's ECG Blog

OCTOBER 17, 2022

In such cases — the 1st priority is to ensure that the ECG they are overseeing does not represent an acute cardiac event that may have been overlooked. There are some unusual ECG findings in today's tracing ( that I labeled in Figure-1 ). There is No Acute Cardiac Event: As per Dr. Smith — there is no acute cardiac event in ECG #1.

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Dr. Smith's ECG Blog

MARCH 22, 2022

see below for more info on this) 1. Although the overwhelming majority of young adults presenting for emergency care who manifest ER patterns on ECG have a benign prognosis — there is a small-but-present percentage of such individuals who go on to develop a lethal cardiac arrhythmic event ( Zakka & Refaat- ACC, 2016 ).

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Don't Forget the Bubbles

MAY 8, 2024

You will find the list is broken down into four sections: 1.Reviews 2024 Apr 9. Associations of excessive internet use, sleep duration and physical activity with school absences: a cross-sectional, population-based study of adolescents in years 8 and 9. 2024 Apr 9:S0890-8567(24)00184-9. 2024 Apr 9.

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REBEL EM

JULY 3, 2023

Investigators enrollend 660 patients in 9 years in 5 EDs; or approximately 6 patients per month; or 1 patient per /month for each ED. The primary purpose of Table 1 is to provide a summary of baseline characteristics and demographics of the study population, presenting data in a clear and organized manner.

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Dr. Smith's ECG Blog

NOVEMBER 14, 2019

I’ve taken th e l ead V 3 examples in Figure-1 from previous cases posted on Dr. Smith’s ECG Blog : T OP in Figure-1 — Despite marked ST elevation in this lead V3 — this is not T-QRS-D, because there is well-defined J-point notching ( BLUE arrow ). Although simple to define — this finding may be subtle!

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Don't Forget the Bubbles

FEBRUARY 5, 2024

Paediatric advocacy still has a long road ahead… You will find the list is broken down into four sections: 1.Reviews 2024 Jan 1;43(1):e11-e13. 2024 Jan 9. 2024 Jan 1;153(1):e2022060119. 2024 Jan 1;153(1):e2023063039. 2024 Jan 1;153(1):e2023063050. 2024 Jan 1;153(1):e2023061659. Myette RL, Flynn JT.

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REBEL EM

JANUARY 30, 2023

PSA, also referred to as intravenous sedation in this paper, requires considerable resources, including 1:1 nursing observation, and burdens the emergency department (ED). 1.01, I2 = 69%, low certainty) Fewer adverse events occurred in the IAL group compared to the PSA group. vs. 91.4%; RR 0.93; 95% CI 0.86–1.01,

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Dr. Smith's ECG Blog

SEPTEMBER 10, 2023

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. As you take another LOOK at ECG #1 — What is the relevance of the findings that I've labeled in Figure-1 ?

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Don't Forget the Bubbles

AUGUST 13, 2023

There is a 1:3 or 30% risk of recurrence of the febrile convulsions and occur within 2 years of the first episode. There is a very low risk of developing epilepsy following febrile convulsions (approximately 2% following simple seizures and 5% following complex seizures as compared to 1% in the general population).

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Dr. Smith's ECG Blog

MARCH 9, 2023

He had episodes of chest pain off and on all night, until about 1 hour prior to arrival when the pain became constant, crushing, 10/10 chest pain that radiated to both arms. Proven STEMI has an open artery in 19% to 36% of cases, depending on whether it is TIMI −1, −2, or −3 flow. 25] Stone et al found that 72% have TIMI 0 or 1 flow.

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Don't Forget the Bubbles

JANUARY 10, 2024

The study asked TWO questions: 1. Transfusion guidelines in LMICs in sub-Saharan Africa differ significantly from the Western world. However, these recommendations are only based on expert opinion and have not been systematically evaluated. Some wonder if giving blood to children with a haemoglobin <6g/dl will improve outcomes.

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REBEL EM

AUGUST 21, 2023

Background Information: Cardiac arrest is a devastating event that imposes considerable human and financial burdens. While it is widely recognized that cardiac arrest leads to brain injury, what is often overlooked is the persistent cerebral hypoperfusion that continues even after circulation is restored. Paper: Eastwood G, et al.

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Don't Forget the Bubbles

OCTOBER 19, 2023

And importantly, adverse event rates were both low and equivalent in both groups. The bottom line is: Early high-flow nasal cannula oxygen started in the ED resulted in a longer length of hospital stay than standard oxygen therapy in children aged 1 – 4 with respiratory failure. days compared to 1.50 days compared to 1.50

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Dr. Smith's ECG Blog

DECEMBER 10, 2019

The pain is described as located in the midsternal area, radiating to the right arm, described as 8-9/10 and worse with deep inspirations. In the evening, he became diaphoretic and complained of 9/10 continuous chest pain. Today’s case provides perhaps the best example of s erial E CG e volution of this elusive entity.

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Don't Forget the Bubbles

NOVEMBER 29, 2023

Intubated, awake, and paralysed: a never event. Intensive Care Research , 1 (3-4), pp.60-64. A never event Never events are usually preventable serious adverse events which should be reported. Tragically, several attempts at resuscitation upon arrival at the emergency department were unsuccessful. Burgart, A.M.

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Dr. Smith's ECG Blog

JANUARY 19, 2020

Another ECG was obtained during pacing: Mostly paced rhythm with PVCs (#3, #6, #9, #12). Consider thrombolytics for OMI when PCI is not an option. == MY Comment by K EN G RAUER, MD ( 1/19/2020 ): == There is a LOT to talk about regarding the series of tracings in this unfortunate case. The cath lab was activated. mm STE with 9.5

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AAEM RSA

AUGUST 27, 2020

1 The primary goal of cardiopulmonary resuscitation (CPR) is to optimize coronary perfusion pressure and maintain systemic perfusion in order to prevent neurologic and other end-organ damage while working to achieve ROSC. Kirkegaard H, Soreide E, de Haas, I et al. Enrollees were then assigned to either TTM of 33ºC or 36ºC for 36 hours.

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