Dr. Smith's ECG Blog

NOVEMBER 19, 2024

These ECGs were texted to me by one of our previous ultrasound fellows, Will Smoot An elderly male arrived via EMS for acute substernal chest pain with radiation to left shoulder and arm that awakened him from sleep at 0030. He took two full strength aspirin prior to EMS arrival. The pain was relieved by one prehospital NTG spray.

OR 64

OR STEMI Coronary CAD 64

REBEL EM

JULY 1, 2024

The AVAPS mode is as effective and safe as BPAP S/T in treating patients with hypercapnic respiratory failure in the ED.” Clinical Take Home Point: I n patients presenting to the ED with hypercapnic respiratory failure, AVAPS did lead to a faster improvement in pH and PaCO2 levels compared to BPAP S/T. AVAPS: 0.07 AVAPS: 10.20

ED 133

ED Emergency Department ALS OR 133

Dr. Smith's ECG Blog

OCTOBER 27, 2024

Here is his EMS ECG: What do you think? Cath lab was activated by EMS and transported emergent." The cath lab was deactivated by cardiologist on arrival at ED because it was "not a STEMI". He presented to the ED for evaluation chest pain. He reported the crushing chest pain radiated down his left arm.

STEMI 119

STEMI ED Coronary EMS 119

EMDocs

OCTOBER 19, 2024

We’ll keep it short, while you keep that EM brain sharp. A 3-year-old male with no previous past medical history, born full term, and unvaccinated presents after 6 days of cough, fever, myalgias, and rhinorrhea. Question: What’s the next step in your evaluation and treatment, and what is the potentially life-threatening diagnosis?

EMS 86

EMS E-9-1-1 Epinephrine OR 86

EMDocs

JUNE 22, 2024

We’ll keep it short, while you keep that EM brain sharp. A 37-year-old G5P4 at 33 weeks presents to the ED after being brought in by ambulance. She had a precipitous delivery while the ambulance was pulling in.

EMS 95

EMS Ambulance FFP ICU 95

Dr. Smith's ECG Blog

MARCH 28, 2024

Per EMS report, patient believes he has been in atrial fibrillation for 5 days, since coming down with flu-like illness with rhinorrhea, productive cough, SOB. On EMS arrival, patient's oxygen saturation was in the high 80s and improved on 4L O2 via nasal cannula. Here is the prehospital ECG: First ED ECG What do you think?

OR 125

OR Emergency Department Ambulance EMS 125

EMDocs

MARCH 2, 2024

We’ll keep it short, while you keep that EM brain sharp. A 58-year-old female with a history of diabetes, hypertension, and chronic back pain presents to the ED with severe headache and nausea. The patient denies any trauma to the head, fevers, nuchal rigidity, changes in vision, focal weakness, paresthesia, or anticoagulation use.

EMS 113

EMS E-9-1-1 OR ED 113

The Skeptics' Guide to EM

NOVEMBER 2, 2024

Guest Skeptic: Dr. Neil Dasgupta is an emergency medicine physician and ED intensivist from Long Island, NY. He is the Vice Chair of the Emergency Department and Program Director of the EM residency program at Nassau University Medical Center in East Meadow, NY, the safety net hospital for Nassau County. AEM Oct 2024. AEM Oct 2024.

Emergency Department 244

Emergency Department ED ALS EMS 244

EMDocs

SEPTEMBER 7, 2024

We’ll keep it short, while you keep that EM brain sharp. A 70-year-old female with a past medical history of hypertension, coronary artery disease s/p 2x drug eluting stent placement one month ago, atrial fibrillation on apixaban presents to the ED with weakness and lightheadedness. Vital signs include BP 90/48, HR 122, T 98.3

EMS 74

EMS E-9-1-1 Operating Room OR 74

EMDocs

MAY 25, 2024

We’ll keep it short, while you keep that EM brain sharp. A 70-year-old female with past medical history diabetes mellitus, hypertension, hyperlipidemia, dementia presents from nursing home with acute unilateral swelling along the left side of her face.

EMS 79

EMS E-9-1-1 OR ED 79

The Skeptics' Guide to EM

OCTOBER 12, 2024

Andrew Tagg Case: You are working with a medical trainee on her first clinical rotation through the emergency department (ED). Working with children in the ED adds another layer of complexity as we are often trying to explain to them and their caregivers what is going to happen during their time in the ED.

Emergency Department 229

Emergency Department ED ALS OR 229

Emergency Medicine Cases

FEBRUARY 11, 2020

The current outbreak of the novel respiratory pathogen Coronavirus is an opportunity to remind ourselves of how to properly and adequately prepare for an emergency outbreak in our EDs. The post Preparation for Emergency Infectious Outbreak in your ED – Coronavirus appeared first on Emergency Medicine Cases.

ED 130

ED EMS OR 130

REBEL EM

MAY 27, 2024

Clinical Question: Does simultaneously performing the modified valsalva maneuver and administering intravenous adenosine, compared to either treatment alone, have greater success in achieving normal sinus rhythm in patients presenting to the ED with PSVT? This absence of detail leaves the study open to bias.

OR 137

OR E-9-1-1 ED ALS 137

EMDocs

JUNE 8, 2024

We’ll keep it short, while you keep that EM brain sharp. A 27-year-old male presents to the ED for left eye pain after being hit in the face with a spare car part while working under the hood of his car. What is the diagnosis, and how do we manage it from the ED? 95% occupational injuries occur in males [1].

EMS 80

EMS Allergic Reaction Emergency Department ED 80

EMDocs

JULY 13, 2024

We’ll keep it short, while you keep that EM brain sharp. A 37-year-old G2P2 female with no other past medical history presents to the ED with a 2-day history of intermittent fever and foul-smelling vaginal discharge. She has significant tenderness to the lower abdomen on palpation. What is the diagnosis?

EMS 63

EMS E-9-1-1 Plasma OR 63

EMDocs

MAY 11, 2024

We’ll keep it short, while you keep that EM brain sharp. A 74-year-old female with a past medical history of hypertension, diabetes, recent basilar artery stent placement with a 20 pack-year smoking history presents to the ED via EMS for altered mental status and episodes of apnea. Vital signs include BP 168/89, HR 96, T 98.3,

EMS 88

EMS E-9-1-1 ALS OR 88

Emergency Medicine Cases

JULY 18, 2023

You are working the ambulatory section of your ED and evaluating a 6-year boy with a possible distal radius injury. He lives with autism spectrum disorder and is uncomfortable in X-ray rooms, and you wonder if there is a role for PoCUS to help exclude a fracture.

OR 130

OR ED EMS 130

EMDocs

APRIL 27, 2024

We’ll keep it short, while you keep that EM brain sharp. A 68-year-old male with a history of poorly controlled diabetes presents to the ED with increasing right-sided ear and facial pain, swelling, and difficulty hearing for two weeks. He says the pain is worse at night and when he is chewing. and Staphylococcus spp.

EMS 83

EMS ED OR ALS 83

EMDocs

APRIL 13, 2024

We’ll keep it short, while you keep that EM brain sharp. A 24-year-old male presents to the ED from a mixed marital arts competition after being struck on the side of the right head by a fist earlier today. The patient denies any loss of consciousness, neck pain, vomiting, or use of blood thinners. RR 15, SpO2 99% on room air.

EMS 81

EMS E-9-1-1 OR Emergency Department 81

The Skeptics' Guide to EM

SEPTEMBER 21, 2024

Chris Root is an emergency medicine and emergency medicine service (EMS) physician at the University of New Mexico, Albuquerque. Chris completed his emergency medicine residency and EMS fellowship at UNM. Before attending medical school, he was a New York City Paramedic. Your partner asks if you want to administer naloxone as well.

Naloxone 242

Naloxone NARCAN Overdose CPR 242

Pulsara

JANUARY 25, 2024

With a new protocol and Pulsara, Metropolitan Emergency Medical Services can now transport eligible pediatric behavioral health patients directly to behavioral health facilities—resulting in a 44% decrease of pediatric behavioral health patients transported to the ED. Download the case study or read on to learn more!

Emergency Medical Services 109

Emergency Medical Services EMS STEMI Emergency Department 109

REBEL EM

JANUARY 25, 2024

In many emergency departments (ED), US machines are readily available and can be used to rapidly assess and monitor patients with acute dyspnea at the bedside. US, compared with CXR and CT, offers the absence of ionizing radiation and high reproducibility. Emerg Med J. 2023;40(10):700-707.

ED 130

ED E-9-1-1 Emergency Department ALS 130

Dr. Smith's ECG Blog

NOVEMBER 29, 2023

Written by Pendell Meyers Two adult patients in their 50s called EMS for acute chest pain that started within the last hour. Both cases had an EMS ECG that was transmitted to the ED physician asking "should we activate the cath lab?" 25 minutes later, EMS called back with this new ECG: Super obvious STEMI(+) OMI.

OR 120

OR STEMI EMS ED 120

REBEL EM

JULY 17, 2023

REBEL Cast Ep120: Etomidate vs Ketamine for RSI in the ED? PMID: Clinical Question: Does a single dose of ketamine or etomidate used for rapid sequence intubation (RSI) of critically adults in the ED impact the SOFA score within 3 days of hospitalization? Click here for Direct Download of the Podcast Paper: Knack SKS et al.

ED 98

ED ICU Emergency Department Overdose 98

Core EM

JANUARY 25, 2024

A narrow pulse pressure has been shown to predict the need for hemorrhage control in the ED setting but has not been assessed as a predictor in the prehospital setting. A narrow pulse pressure occurs due to compensatory increased systemic vascular resistance in the setting of decreased cardiac output.

Operating Room 246

Operating Room EMS ED ICU 246

EMDocs

JUNE 27, 2023

Authors: Anthony Rodriguez, MD (EM Resident Physician, Denver Health); Spencer Tomberg, MD (EM Attending Physician, Denver Health); and Matthew Folchert, MD (Orthopedic-Hand Attending Surgeon, Denver Health) // Reviewed by: Alex Koyfman, MD (@EMHighAK); Manny Singh, MD (@MPrizzleER); Brit Long, MD (@long_brit) Case: A 35-year-old right hand dominant (..)

ED 67

ED EMS OR 67

REBEL EM

MAY 15, 2023

You are working in a rural ED, and an older woman from a local assisted care facility arrives via ambulance in obvious respiratory distress. EMS is able to tell you that she is currently being treated for pneumonia. The patient is on a nonrebreather mask, and vital signs on arrival are BP 110/50 mm Hg, HR 120 bpm, RR 40/min, T 98.6°F

EMS 98

EMS Ambulance ED OR 98

Emergency Medicine Cases

JUNE 18, 2019

Whether you're studying for an exam or need to brush up on Pediatric EM because your ED doesn't see many pediatric patient, or you just want to make sure you etch all the practice enhancing pearls from the EM Cases main episode podcasts, The Quiz Vault will help you on your path to b the best EM provider you can be!

EMS 130

EMS ED OR 130

Emergency Medicine Cases

OCTOBER 13, 2020

In this podcast, Part 2 of our diabetic emergencies series with Melanie Baimel, Bourke Tillmann and Leeor Sommer, we dive into the recognition and ED management of Hyperglycemic Hyperosmolar State (HHS). Why is finding and treating the cause or trigger of HHS so important in the ED? How does fluid management differ in HHS from DKA?

ED 130

ED OR EMS 130

The Skeptics' Guide to EM

OCTOBER 3, 2021

Case: A 66-year-old woman is brought in by EMS from home with lethargy and hypotension. Some bench work, observational studies, and now two large, unblinded, cluster-randomized single-center trials ( SMART and SALT-ED ) suggested a benefit to using balanced crystalloids (i.e. Date: September 28th, 2021 Reference: Zampieri et al.

OR 130

OR Critical Care ICU Plasma 130

EMS 12-Lead

APRIL 9, 2024

David Didlake @DidlakeDW EMS personnel responded to the residence of an 81 y/o Male with syncope. At the time of ED arrival he was alert, oriented, and verbalizing only a headache with a normalized BP. The ED activated trauma services, and a 12 Lead ECG was captured. This was deemed “non-specific” by the ED physicians.

Coronary 290

Coronary ACS CAD ED 290

The Skeptics' Guide to EM

JUNE 1, 2024

His research focuses on the pre-hospital care of children by EMS. He is the principal investigator for EMSC State Partnership in Washington, DC and is also involved in various multi-center EMS studies with the Pediatric Emergency Care Applied Research Network (PECARN). EMS placed him in a C-collar and brought him to you.

Emergency Medical Services 210

Emergency Medical Services Emergency Department EMS ALS 210

EMDocs

SEPTEMBER 9, 2023

We’ll keep it short, while you keep that EM brain sharp. He presents to the ED with profound difficulty extending his middle and ring finger. A 35-year-old right handed male with no significant past medical history presents with a deep hand laceration. The patient states they suffered a cut with a box cutter at a construction site.

EMS 77

EMS ED ALS Emergency Department 77

Medic Mindset

NOVEMBER 13, 2024

Dr. Casey Patrick is the EMS medical director of Montgomery County Hospital District (Texas). As an EM physician, he shares how he decides to care for his own patients in the ED who present with rapid atrial fibrillation. Here’s how. He shares with listeners how he came to the decision to remove Diltiazem from his service.

Paramedic 98

Paramedic Emergency Department EMS ED 98

EMDocs

JULY 17, 2023

and is poorly tolerated by patients with obstruction, it should not be a routine part of the ED evaluation for LBO unless it is critical for another diagnosis on the differential. He describes the pain as a gradually worsening pressure-like discomfort distributed across his entire abdomen. He reports distension and the sensation of fullness.

E-9-1-1 76

E-9-1-1 ED Operating Room ALS 76

Dr. Smith's ECG Blog

SEPTEMBER 11, 2024

Here is the case: Report from EMS was witnessed syncope, his son did CPR, but the patient had pulses when EMS arrived. When the patient arrived in the ED, he was still hypotensive in 70s, slowly improving with EMS fluids. Here is the ED ECG (a photo of the paper printout) What do you think?

EMS 110

EMS CPR ED Coronary 110

The Skeptics' Guide to EM

NOVEMBER 16, 2024

Case: The Chief of Emergency Medicine (EM) at a large urban hospital recently approached the AI Committee at Unity Health, intrigued by the CMAJ article describing the apparent success of CHARTWatch in detecting early signs of patient deterioration. Background: There are many ways to define artificial intelligence.

ICU 142

ICU Emergency Department ALS EMS 142