Dr. Smith's ECG Blog

MAY 13, 2024

Chest Pain – Benign Early Repol or OMI? Written by Destiny Folk, MD, Adam Engberg, MD, and Vitaliy Belyshev MD A man in his early 60s with a past medical history of hypertension, type 2 diabetes, obesity, and hyperlipidemia presented to the emergency department for evaluation of chest pain. But — Which ST-T wave is the "correct" one? (

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OR STEMI Heart Attack Coronary 108

St. Emlyn's

JANUARY 3, 2024

St.Emlyn's - Emergency Medicine #FOAMed Just before midnight at the NYE dinner party I was hosting the guests started to ask around the table “what are your New Year’s resolutions?”. Many people disclosed that they … Resolutions or Habits? St Emlyn’s Read More » The post Resolutions or Habits?

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OR 111

REBEL EM

MAY 27, 2024

What they did: Prospective randomized controlled trial, unblinded, multicenter study Conducted from January 2017 to December 2022 Patients with confirmed PSVT were randomly assigned to receive MVM, IV Adenosine, or combined therapy. This absence of detail leaves the study open to bias. Evidence suggests that a weight-based dosing approach (0.1

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OR E-9-1-1 ED ALS 137

St. Emlyn's

OCTOBER 21, 2024

St.Emlyn's - Emergency Medicine #FOAMed Should we use AP or AL pad position first for defibrillation in VF/VT cardiac arrest. Critical appraisal of an observational study in JAMA suggests a better outcome with AP, but there are many biases in this study. FOAMed @stemlyns The post JC: AP or AL pad position for first choice shock in VF?

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ALS OR Defibrillator 102

FOAMfrat

SEPTEMBER 24, 2024

It’s probably safe to assume that your patient has a traumatic brain injury, so at what point in your treatment pathway do you reach for an antiepileptic drug (AED)? Are you carrying antiepileptics on your truck or aircraft? To give an AED or not to give an AED, that is the question. (Bet Bet you thought you left Shakespeare in high school).

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OR ALS 106

Dr. Smith's ECG Blog

OCTOBER 21, 2023

This was my situation in today’s case — for which I was initially shown the ECG in Figure-1 , knowing only that this 70-ish man presented in severe respiratory distress. From a purely ECG interpretation standpoint — How would you interpret today's rhythm ? Figure-1: The initial ECG in today's case. Is this sinus tachycardia or VT?

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OR 136

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. Patient is on rivaroxaben, carvedilol, and dofetilide (to suppress atrial fib -- rhythm control). He states that he maybe missed a dose or two during recent illness. SVT with aberrancy?

OR 121

OR Emergency Department Ambulance EMS 121

St. Emlyn's

OCTOBER 26, 2024

This review critically examines the methodology, results, and potential implications for emergency medicine practice, especially regarding the prehospital administration of TXA for TBI patients. Key insights for trauma care providers included. The post 2g or 1+1g TXA in traumatic brain injury? appeared first on St.Emlyn's.

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High Performance EMS

JANUARY 20, 2022

Not to give any details of the factual-based story away, I see many parallels between the implementation of sabermetrics in baseball and system status management in EMS. There must be buy-in, or at the very least a willing curious acceptance , throughout the organization before significant change can be successful.

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Dr. Smith's ECG Blog

DECEMBER 27, 2023

The definition requires the following three components: An end QRS notch (sometimes called a J wave) or slur, in the case of a slur it must lie entirely above the isoelectric baseline The peak amplitude of the notch or slur should be ≥ 0.1 In leads aVL and III, we see a change in ST segment morphology from markedly concave to much more angular.

E-9-1-1 116

E-9-1-1 OR Coronary ACS 116

St. Emlyn's

DECEMBER 26, 2023

St.Emlyn's - Emergency Medicine #FOAMed Air France Flight 447 takes off at 1930hrs on the final day of May in 2009, from Rio de Janeiro en route to Paris, carrying 228 passengers. In charge is … AI & Medicine: Saviour or Snake Oil? Read More » The post AI & Medicine: Saviour or Snake Oil? appeared first on St.Emlyn's.

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Dr. Smith's ECG Blog

NOVEMBER 11, 2024

It can be seen in other forms of heart block as well (such as complete heart block). See Ken Grauer 's comment below for more on this. As this patient is scheduled for imminent elective surgery, it is important to determine whether this is Mobitz I (benign) or Mobitz II (requires pacing). So.Which is it? History is often helpful.

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OR E-9-1-1 Coronary 71

First 10 EM

OCTOBER 7, 2024

Physicians have moved beyond the days of removing blood from their patients, but we still aren’t totally sure when we are supposed to put blood back in.

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OR EMS 83

Emergency Medicine Cases

JULY 18, 2023

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. With expert clinical commentary by Dr. Arun Sayal and Research Methodology Hot Take by Dr. Shelley Mcleod.

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First 10 EM

APRIL 29, 2024

Clearly trajectory matters. If a patient’s GCS hit 8 and they are on a clinical course where you expect […] The post GCS 8 obviously doesn’t mean intubate (in tox or otherwise) appeared first on First10EM.

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OR EMS 112

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?

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OR Firefighter NFPA EMT 116

ACEP Now

APRIL 5, 2024

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. The authors conclude, “despite the certainty of evidence being low, these data suggest that a bougie should probably be used first and not as a rescue device.” 2021;40(2).

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OR ALS Emergency Department Critical Care 73

First 10 EM

DECEMBER 25, 2023

Throughout the length of my career, we have consistently heard that less is more when it comes to blood transfusions (outside of the critically ill requiring massive transfusion, where the message, correct or not, has been the exact opposite).

OR 106

OR Coronary EMS 106

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.

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OR Emergency Medical Technician CPR Emergency Medical Services 91

St. Emlyn's

OCTOBER 21, 2024

St.Emlyn's - Emergency Medicine #FOAMed Should we use AP or AL pad position first for defibrillation in VF/VT cardiac arrest. Critical appraisal of an observational study in JAMA suggests a better outcome with AP, but there are many biases in this study. FOAMed @stemlyns The post AP or AL pad position for first choice shock in VF?

ALS 52

ALS OR Defibrillator 52

Don't Forget the Bubbles

OCTOBER 2, 2024

Guidelines for the management of pediatric severe traumatic brain injury, third edition: Update of the brain trauma foundation guidelines. Pediatric Critical Care Medicine. How This study was an observational, comparative effectiveness study comparing 3% hypertonic saline with mannitol rather than to a control. References Vavilala M, Tasker R.

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OR Critical Care ALS Emergency Department 49

First 10 EM

NOVEMBER 4, 2024

It is pretty rare for the phrase “we need more research” to be immediately followed by more research, but that seems to have happened here.v

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Dr. Smith's ECG Blog

NOVEMBER 17, 2024

Since the patient has active pain, that is less likely. In any case, I would call this diagnostic of inferior OMI and it requires cath lab activation. Is this: 1) inferior OMI with benign T-wave inversion in precordial leads? or 2) Inferior and lateral OMI that is beginning to reperfuse, even though the patient still has chest pain?

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OR 72

Critical Care Scenarios

MAY 31, 2023

A brief overview and call to arms around the key concepts of ICU liberation. A brief overview and call to arms around the key concepts of ICU liberation.

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OR ICU 100

International Journal of Paramedicine

JULY 22, 2024

Traditionally, students have been tested under pressure in scenario-based situations as a means of stress inoculation. However, the literature is unclear as to whether this enhances or hinders learning. A recent scoping review identified an acceptable level of stress during simulation can be beneficial, although a level of a balance is required.

Paramedicine 111

Paramedicine Paramedicine OR Paramedic 111

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.

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OR STEMI ACS Coronary 66

ALiEM

FEBRUARY 28, 2024

Clinical photograph for: Ludwig Angina. CorePendium. For Media Without an Associated Publication: This type of citation may be helpful if the image is used in multiple places within a publication, or if it is not tied to a particular publication. In the example below, there is no specified date of publication for the image. Last Name First Initial.

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Dr. Smith's ECG Blog

SEPTEMBER 18, 2024

Thus, the lumen observed may actually still be the same size as the original, normal lumen. Furthermore, in studies reporting progression of insignificant lesions to total thrombotic occlusions, the mean interval between angiography and acute myocardial infarction is 2.5 years, with the interval as long as 12 or 18 years in some studies.

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Coronary ACS OR EMR 115

The Skeptics' Guide to EM

OCTOBER 3, 2021

Aaron Skolnik is an Assistant Professor of Emergency Medicine at the Mayo Clinic Alix School of Medicine and Consultant in […] The post SGEM#347: It Don’t Matter to Me – Balanced Solution or Saline first appeared on The Skeptics Guide to Emergency Medicine. Date: September 28th, 2021 Reference: Zampieri et al.

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Dr. Smith's ECG Blog

MAY 29, 2024

Written by Pendell Meyers Two patients with acute chest pain. Do either, neither, or both have OMI and need reperfusion? Patient 1: Patient 2: Patient 1: A man in his 40s with minimal medical history presented with acute chest pain radiating to his R shoulder.

CAD 100

CAD OR STEMI 100

Medgadget

SEPTEMBER 14, 2023

Researchers at the National University of Singapore have developed a highly sensitive pressure sensor that can provide haptic feedback for surgeons using laparoscopic tools or for use in robotic grippers as part of robotic surgical systems.

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OR 93

The Skeptics' Guide to EM

FEBRUARY 13, 2021

Pediatrics 2020 Case: A 4-year-old immunized girl presents to the emergency department (ED) with a fever and rhinorrhea for the […] The post SGEM#319: Is it Aseptic Meningitis or More Than This? first appeared on The Skeptics Guide to Emergency Medicine. On exam, she is febrile to 38.5 She does not have any petechiae or purpura on skin exam.

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OR Emergency Department ALS ED 130

Emergency Medicine Cases

DECEMBER 16, 2019

In this ECG Cases blog we look at seven patients with potentially ischemic symptoms and subtle ECG changes in the lateral leads. Which had acute coronary occlusion? Introducing the concept of Occlusion MI - a paradigm shift in ECG diagnosis of MI. The post ECG Cases 4: Lateral STEMI or Occlusion MI? appeared first on Emergency Medicine Cases.

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STEMI OR Coronary 130

The Skeptics' Guide to EM

FEBRUARY 11, 2023

first appeared on The Skeptics Guide to Emergency Medicine. Date: February 7, 2023 Reference: Cheskes et al. One issue that has not been covered on the SGEM is pad placement and double sequential external defibrillation. Reference: Cheskes et al. Defibrillation Strategies for Refractory Ventricular Fibrillation.

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Defibrillator Medical Transportation OR CPR 139

Emergency Medicine Cases

OCTOBER 22, 2019

In this ECG Cases blog we present ECGs from 7 patients who presented with chest pain and mild anterior ST elevation. Can you identify which were early repolarization and which were anterior STEMI? The post ECG Cases 2: Early Repolarization or Anterior STEMI? appeared first on Emergency Medicine Cases.

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STEMI OR EMS 130

ACEP Now

JULY 7, 2023

Out-of-hospital cardiac arrest is a commonly encountered entity in U.S. emergency departments (EDs), with statistics reporting more than 356,000 out-of-hospital cardiac arrests per year. 2 Standard management for VT and VF involves the use of electrical defibrillation, high-quality chest compressions, and epinephrine. amiodarone or lidocaine).

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Defibrillator OR ALS Epinephrine 98

EMOttawa

MAY 31, 2024

Questions and methods: This multicenter, open-label, RCT of 3604 patients with MI with anemia compared 30-day all-cause mortality and recurrent nonfatal MI between liberal vs restrictive transfusion thresholds.

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OR ALS 60