Dr. Smith's ECG Blog

OCTOBER 15, 2024

Patient # 1: Assessment of the Initial ECG in the ED … The History for Patient #1 — is clearly concerning for a higher -risk likelihood of having an acute event. Patient # 2: Assessment of the Initial ECG in the ED … While still of concern — I found the history for Patient #2 of a lower likelihood for an acute event.

OR 104

OR STEMI Coronary ED 104

Pediatric EM Morsels

JULY 19, 2024

If bleeding has completely stopped, most of these children still come into the hospital for observation so access will likely be necessary and helpful should patient have rebleed event. Resolved Bleeding on Arrival Nebulized TXA: Even in the setting of bleeding that has stopped, nebulized TXA has been shown to reduce rebleeding events.

E-9-1-1 286

E-9-1-1 Epinephrine Emergency Department OR 286

Dr. Smith's ECG Blog

OCTOBER 1, 2023

This history immediately places this patient in a high -prevalence population for having an acute event. Thus, the role of the emergency provider has to be proving that an acute event is not happening — rather than the other way around. It's OK not to be certain from the initial ECG as to whether or not an acute event is occurring.

OR 127

OR STEMI Coronary CAD 127

High Performance EMS

MARCH 8, 2024

It may be better to account for the coverage of recommended demand maintained based on a measured forecast for evaluation of performance, for instance, than simply reviewing specific results at the end of an event. It is also important that the decision criteria be flexible to adjust quickly to any changes in the business environment.

Public Safety 278

Public Safety OR 278

NVFC

MARCH 12, 2024

However, departments that protect fewer than 2,500 people, which are almost all volunteer, have the highest percentage of firefighters over the age of 50 (34%). In many rural areas it is not uncommon to find volunteers in their 60s or 70s. The post Is Volunteerism Dying Or Has Your Marketing Flatlined?

OR 116

OR Firefighter NFPA EMT 116

Core EM

JANUARY 25, 2024

Consider these medications if there are signs of end-organ dysfunction, there is a considerable delta in baseline BP, systolic is less than 90 and/or MAP is less than 65 Norepinephrine is a good pressor for a lot of the situations that we encounter in the emergency department, such as septic shock, undifferentiated shock and hypovolemic shock.

Epinephrine 246

Epinephrine Critical Care Emergency Department ED 246

Dr. Smith's ECG Blog

SEPTEMBER 22, 2023

As discussed above in Dr. Smith's excellent discussion — serial ECGs, correlated to severity of patient symptoms soon confirmed the acute event in today's patient. This is diagnostic of full reperfusion.] An old ECG was found: As you can see, this patient has zero baseline STE, and normal T-waves. 90% of normals have some STE in V2 and V3.

OR 122

OR STEMI Coronary 122

Dr. Smith's ECG Blog

SEPTEMBER 18, 2024

Furthermore, if this occurs at all, it is a rare event. It is not small but rather large plaques, which may not be producing significant stenosis, that undergo rupture with acute occlusive thrombosis, resulting in myocardial infarction and other ischemic events. years, with the interval as long as 12 or 18 years in some studies.

Coronary 114

Coronary ACS OR EMR 114

REBEL EM

NOVEMBER 20, 2023

Early expeditious definitive hemorrhage control is a major focus in trauma resuscitation. Patients with torso hemorrhage present a clinical conundrum often requiring interventional radiology or surgery, both of which take time to mobilize. 2 Despite these recommendations there are no randomized clinical trials to help guide practice until now.

OR 91

OR Emergency Medical Technician CPR Emergency Medical Services 91

Pediatric EM Morsels

SEPTEMBER 22, 2023

Pathophysiology Primary injury happens at the time of the traumatic event or shortly after in the high cervical to mid-thoracic spine. Spinal shock is a phenomenon of transient, physiologic (rather than anatomic) complete loss of spinal cord function inferior to an injury. Thought to be a “stunning” of the spinal cord. Basics are the Best!

E-9-1-1 300

E-9-1-1 Epinephrine ALS EMS 300

The Skeptics' Guide to EM

NOVEMBER 16, 2024

Their hospital has struggled with a growing number of adverse events that often occur without warning. Clinical Question: Can the implementation of a real-time, machine learning-based early warning system (CHARTWatch) reduce adverse events and mortality in patients in the emergency department? Reference: Verma et al.

ICU 212

ICU Emergency Department ALS EMS 212

The Skeptics' Guide to EM

AUGUST 17, 2024

Networking Opportunities: The conference provides a unique platform to connect with peers, thought leaders, and industry professionals from around the world, fostering collaborations that can continue long after the event. Five Questions about IncrEMentuM Listen to the podcast to hear Francisco and Carmen answer the five questions.

EMS 218

EMS OR 218

Core EM

JANUARY 25, 2024

mEq/L Effect starts 10-20 mins after administration and can last 4-6 hours Albuterol 10-20 mg over 10 mins (NB: higher dose than for asthma) Peak effect at 90 mins Decreases by 0.5 – 1.0 mEq/L alone With insulin, ~1.2 mEq/L, additive effect Bicarbonate Controversy. mEq/L alone With insulin, ~1.2

Epinephrine 246

Epinephrine ED OR 246

ACEP Now

APRIL 5, 2024

Techniques, success, and adverse events of emergency department adult intubations [published correction appears in Ann Emerg Med. A study in the February issue of Annals conducted a meta-analysis of 18 studies and concluded that bougie use was associated with increased first-attempt intubation success. percent with use of a bougie and 83.0

OR 73

OR ALS Emergency Department Critical Care 73

The Skeptics' Guide to EM

JULY 6, 2024

Conflicts in the ED often stem from clinical decision-making and actions, leading to potential adverse patient events and exacerbating access block issues. An abdominal pelvic CT scan demonstrates uncomplicated left-sided diverticulitis. Background: We have discussed agitation in the ED on the SGEM several times.

ED 197

ED ALS Emergency Department OR 197

REBEL EM

FEBRUARY 19, 2024

events/1000d of peripheral IV infusion) 60% of extravasations caused no or minimal tissue injury (Infiltration grade 0 to 1) No patient required surgical intervention Protocol Criteria Met: 355 patients (55.1%) failed to meet at least one component of the protocol at some point during peripheral IV norepinephrine Catheter size: 83.3% (i.e.

ICU 137

ICU EMS ALS OR 137

Chicago EMT Training

AUGUST 6, 2021

Standby EMS for events The company that comes to mind in Chicago is Event Medical Solutions. Standby EMS for events The company that comes to mind in Chicago is Event Medical Solutions. The biggest event they provide EMS for recently is Lollapalooza. It opens many doors in various industries.

EMT 130

EMT EMT Paramedic Plasma 130

NVFC

SEPTEMBER 10, 2024

The impact was significant: about half of the departments that hosted a screening during a recruitment event enlisted new volunteer firefighters or received strong inquiries, and one station received a $350,000 grant after screening it for state representatives. Want to host a watch party or hold your own FREE recruitment event?

Firefighter 122

Firefighter First Responder OR 122

REBEL EM

JUNE 26, 2023

This could potentially help improve thrombin generation, reduce blood product consumption, but also could increase the risk of thromboembolic events. Some clinicians have advocated for early administration of 4-factor prothrombin complex concentrate (4F-PCC) based on limited observational data. to 3.33; P = 0.72 to 2.10; P = 0.03

FFP 143

FFP Frozen Plasma ALS Plasma 143

REBEL EM

FEBRUARY 15, 2024

Clinical Take Home Point: In patients with decreased level of consciousness due to acute poisoning a conservative strategy of withholding intubation leads to less ICU admissions, median length of ICU/hospital stay, and a lower risk of adverse events. This decreases generalizability to other substances. References: Freund Y et al.

ICU 141

ICU ALS ED OR 141

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. Musculoskeletal Adverse Events include: Articular cartilage damage causing arthralgias or arthritis , Tendonitis , and Tendon rupture. Which is a risk of 1 event for 62.5

E-9-1-1 130

E-9-1-1 ACS OR ALS 130

Critical Care Scenarios

JUNE 26, 2024

This is primarily an experience of inattention, with relatively little awareness of their circumstances, the day, the context for events, and the presence of often-vivid hallucinations and delusions. * Find us on Patreon here! Buy your merch here! Delirium often dominates the patient experience of the ICU.

ICU 169

ICU OR 169

ALiEM

SEPTEMBER 13, 2024

He had no other complaints and denied any other trauma or loss of consciousness during the event. On arrival to our emergency department, the patient expressed continued eye pain with bloody discharge as well as blurry vision from his right eye. Extraocular movements intact. Ocular pressure deferred. 1 mm superior eyelid laceration.

Emergency Department 161

Emergency Department OR ED 161

Emergency Medicine Cases

JULY 30, 2024

Compassion in not simply innate; like any behaviour, it can be learned through deliberate practice.

OR 130

OR EMS 130

ALiEM

OCTOBER 11, 2024

Common inciting events include viral infections, autoimmune diseases, or immunodeficiency syndromes [1]. On the day of presentation, she developed a painful, intermittently bleeding “blood blister” to the left lower cheek that had increased in size, as well as new red spots on her arms and legs. Physical Exam Vitals : 98.3°F; Plt 6, WBC 10.3

OR 152

OR ALS 152

NVFC

MAY 21, 2024

Practical tips for diversity, equity, and inclusion in your community First responders are consistently exposed to a variety of traumatic experiences on calls and though these events can certainly affect a first responder’s mental wellbeing, often these traumatic calls can be met with resiliency. Here are a few quick tips from each category.

First Responder 98

First Responder First Aid OR 98

Core EM

JANUARY 25, 2024

Supplement additional dextrose prn, if hypoglycemia occurs do not stop the insulin, increase the rate of the dextrose drip. Potassium Shifted intracellularly by insulin, total body potassium is normal Replete to goal 3-3.5 Potassium Shifted intracellularly by insulin, total body potassium is normal Replete to goal 3-3.5

Overdose 246

Overdose ALS Epinephrine Critical Care 246

NVFC

AUGUST 13, 2024

Earlier fires or thermal events have also reshaped the energy storage industry’s approach to BESS system design and safety. In addition, layered protections are designed to address specific battery failure modes to greatly diminish the likelihood of any singular battery cell failure from cascading into a larger thermal runaway event or fire.

Firefighter 105

Firefighter NFPA Emergency Response OR 105

Dr. Smith's ECG Blog

OCTOBER 8, 2024

KEY Point: The important distinction that has to be made in today's case, is between ECG findings consistent with this patient's prior LAD OMI — vs — ECG findings of a new acute event superimposed on these prior ECG findings. My "eye" was immediately drawn to leads V1 , V2 , V3 ( within the RED rectangle ).

OR 106

OR STEMI ICU Coronary 106

NVFC

AUGUST 13, 2024

Emergency responders see traumatic events on a regular basis, putting them at risk for many behavioral health challenges, including acute and post-traumatic stress, anxiety, relationship challenges, addiction, suicidal thoughts, and more. Each attendee of the event will then teach the curriculum at trainings across the nation.

Firefighter 122

Firefighter First Responder EMS Emergency Management 122

The Skeptics' Guide to EM

JULY 27, 2021

First, it was difficult to get VIP tickets to this sold out event hosted by James Cowley. After obtaining a couple of VIP tickets to the event, the next concern was: what colour of shirt to wear? I called the Stratford Festival a few months before the event and asked for their assistance.

OR 132

OR 132

Core EM

OCTOBER 16, 2024

Author: Natalie Bertrand, MD Editor: Naillid Felipe, MD Background: Definition: adverse reaction to blood product administration Incidence: more common in children than adults, except for delayed hemolytic transfusion reactions Allergic (non-anaphylaxis) – Platelets 1-3%; RBCs 0.1-0.3% mg IF requiring IM Epi >3x, switch to IV Epi, 0.05-0.1

Allergic Reaction 188

Allergic Reaction Plasma ED Epinephrine 188

NVFC

MARCH 20, 2024

The National Volunteer Fire Council (NVFC) recently hosted its first Wildland Fire Assessment Program (WFAP) Advocate train-the-trainer event for a new network of regional representatives that will teach the WFAP curriculum and advocate for mitigation and safety in wildfire-prone areas across the U.S. The WFAP is a joint effort by the U.S.

OR 116

OR 116

REBEL EM

MAY 25, 2023

mental status, urine output, capillary refill) is more important than an actual goal PERMISSIVE HYPOTENSTION IN PTS WITH TBI Brotfain E et al. Ann Emerg Med 2017 [6] This was a retrospective database review of 7521 traumatic brain injury patients SBP target ≥90mmHg resulted in a mortality of 7.8%

E-9-1-1 145

E-9-1-1 Plasma ALS OR 145

Dr. Smith's ECG Blog

SEPTEMBER 25, 2024

A healthy 45-year-old female presented with chest pain, with normal vitals. The computer interpretation was “ST elevation, consider early repolarization, pericarditis or injury.” What do you think? There’s normal sinus rhythm, normal conduction, borderline right axis, and normal voltages. There’s TWI in aVL but this is concordant to its QRS.

OR 69

OR STEMI ACS Coronary 69

International Journal of Paramedicine

JULY 8, 2024

However, ketamine may be associated with adverse clinical events including a higher intubation rate. Secondary endpoints included the percentage of patients who achieved an improved RASS score post drug administration, the use of additional sedating agents and the need for airway and breathing support, and differences in adverse events.

Emergency Department 98

Emergency Department Ambulance ED OR 98

NVFC

OCTOBER 3, 2024

State Farm and the NVFC will join 10 of the winners for a local open house or fire prevention education event throughout the fall. Learn more about the program and these events at www.nvfc.org/statefarm. In the first year of the program, grant applications were limited to 500. View the list of recipients here.

Firefighter 119

Firefighter First Responder EMS OR 119