Dr. Smith's ECG Blog

DECEMBER 19, 2023

link] A 62 year old man with a history of hypertension, type 2 diabetes mellitus, and carotid artery stenosis called 911 at 9:30 in the morning with complaint of chest pain. Challenge QUESTION: The relative change in T-QRS-D is not the only thing that changes during period of time that passed between recording of the 2 ECGs shown in Figure-1.

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Dr. Smith's ECG Blog

AUGUST 14, 2024

R waves 6 through 9 have no preceding P waves and are suspiciously regularly spaced. Impulses E, F, G, H, and I were blocked. Progress in Biophysics and Molecular Biology , 120 (1–3), 164–178. Science Translational Medicine , 9 (400). Figure-1: I've labeled the initial ECG in today's case to illustrate my theory.

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Pediatric EM Morsels

MAY 5, 2023

2018 Dec 20;11(1):5. Hovinen T, Korkalo L, Freese R, Skaffari E, Isohanni P, Niemi M, Nevalainen J, Gylling H, Zamboni N, Erkkola M, Suomalainen A. Lemale J, Mas E, Jung C, Bellaiche M, Tounian P; French-speaking Pediatric Hepatology, Gastroenterology and Nutrition Group (GFHGNP). 2013 Aug;110(4):755-73. Epub 2013 Jan 14.

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Broome Docs

MAY 31, 2024

Freund Y, Viglino D, Cachanado M, Cassard C, Montassier E, Douay B, Guenezan J, Le Borgne P, Yordanov Y, Severin A, Roussel M, Daniel M, Marteau A, Peschanski N, Teissandier D, Macrez R, Morere J, Chouihed T, Roux D, Adnet F, Bloom B, Chauvin A, Simon T. PMID: 37019501 Pulmonary primatology is harder than you may think Drew T, Võ ML, Wolfe JM.

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This Podcast Will Kill You

JULY 23, 2024

Official journal of the American College of Gastroenterology| ACG , 118 (1), pp.59-76. Annals of internal medicine , 172 (1), pp.ITC1-ITC16. ” BMC medicine 17 (2019): 1-20. . ” BMC medicine 17 (2019): 1-20. Gastroenterology , 160 (1), pp.63-75. ” Internal and emergency medicine 9 (2014): 249-256.

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This Podcast Will Kill You

JULY 1, 2025

Scientific Opinion on the re‐evaluation of Sunset Yellow FCF (E 110) as a food additive. Scientific Opinion on the re‐evaluation of Allura Red AC (E 129) as a food additive. Scientific Opinion on the re‐evaluation Tartrazine (E 102). Refined exposure assessment for Allura Red AC (E 129). EFSA Journal, 9(1), p.1854.

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REBEL EM

SEPTEMBER 13, 2023

Features Urticaria and pruritis Rapid onset (1-2 hours) IgE Dependent (Type I Hypersensitivity) Reactions An allergen cross-links two or more IgE molecules on mast cells or basophils and initiates a signal cascade leading to degranulation. J Emerg Med 2013; 44 (4): 764-772. J Allergy Clin Immune Tract 2017; 5(5): 1402-9.

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Frozen Plasma Allergic Reaction FFP Plasma 101

EMDocs

NOVEMBER 21, 2023

Epidemiology: Prevalence of hypoPP is approximately 1 per 100,000. 2022;26(1):123-125. 2013 Jan;47(1):41-5. 2006 Jan;129(Pt 1):8-17. 2004 Nov 9;63(9):1647-55. 2013 Dec;19(6 Muscle Disease):1598-614. Fournier E, Arzel M, Sternberg D, et al. Tan SV, Matthews E, Barber M, et al.

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REBEL EM

JANUARY 25, 2024

What They Did: Design: Randomized, controlled, blinded-outcome trial Sites: Three emergency departments in Denmark Duration: October 9, 2019 to May 26, 2021. The first evaluation of the patient was to be done within 1 hour of arrival to ED (Including the first POCUS). to −0.66) and −1.66 (95% CI −2.09

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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. Which is a risk of 1 event for 62.5 Etminan 2019) In Belgium between 2010 – 2013, of the 262 children treated with fluroquinolones while hospitalized, only 17% were used for labelled indications.

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This Podcast Will Kill You

JULY 8, 2025

Human reproduction, 33(9), pp.1602-1618. Stener-Victorin, E., The lancet Diabetes & endocrinology, 10(9), pp.668-680. BMJ medicine, 2(1), p.e000548. Ricardo Azziz, and Sharon E. Frontiers in endocrinology, 9, p.452. Journal of endocrinological investigation, 41(1), pp.49-57. Chicano-Gálvez, E.,

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EMDocs

MAY 11, 2024

CT head without contrast 1 is performed and reveals the following: Question: What is the diagnosis? Semin Ultrasound CT MR. 2013 Apr;34(2):131-41. Updated November 9, 2023. On exam, the patient opens eyes to voice, has extraocular movements intact, is unable to speak, and has 0/5 strength in all extremities. doi: 10.1053/j.sult.2013.01.004.

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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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REBEL EM

FEBRUARY 24, 2025

1 They noticed how spontaneously breathing patients had their IVC collapse with inspiration; and ventilated patients had their IVC dilate during positive pressure ventilation. Oct 2013; PMID: 24079262 Gohar E, et al. Mar 2004; PMID: 15090949. Marik P, et al. Does the Central Venous Pressure Predict Fluid Responsiveness?

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EMDocs

OCTOBER 30, 2023

1 The shortage in supply posed difficulties for hospitals that significantly depend on GE Healthcare as their supplier, which encompassed approximately 50% of hospitals in the United States (US). 3 A study of CT use trends in the ED has shown increasing use of CTs by almost 60% from 2005 to 2013. 11 Table 1.

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Dr. Smith's ECG Blog

JUNE 30, 2023

Queen: #1: NOT OMI, HIGH CONFIDENCE Queen: #2: NOT OMI, HIGH CONFIDENCE ECG 1 Interpretation: there is terminal T-wave in V3-V6. LEARNING POINT : 1. For clarity in Figure-1 — I've reproduced and put together the 2 serial ECGs that were texted to Dr. Smith in today's case. in ECG #1 ). Smith: Young thin black male.

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Dr. Smith's ECG Blog

FEBRUARY 16, 2019

Posterior STEMI" may not even technically exist according to the current (2013) ACC/AHA STEMI guidelines, as it is not described as a "STEMI equivalent" and the only relevant statement in the guidelines is: "In addition, ST depression in 2 precordial leads (V1-V4) may indicate transmural posterior injury."

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Dr. Smith's ECG Blog

MARCH 22, 2022

see below for more info on this) 1. BOTTOM Line: Great point by Dr. Meyers to emphasize the strong likelihood of a benign prognosis associated with tracings like ECG #1 in Figure-1. Figure-1: Comparison of the initial ECG in today's case — with a baseline ECG obtained 1 year earlier ( See text ).

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This Podcast Will Kill You

SEPTEMBER 10, 2024

Perantoni, E., Kaimakamis, E., ” American Journal of Cardiology 111.12 (2013): 1823-1828. JMIR Medical Informatics, 9(1), p.e22753. . “Laennec, the Man—1781–1826.” ” The Boston Medical and Surgical Journal 195.5 1926): 208-211. Lung sounds recordings: Rocha, B.M., Vogiatzis, I., Oliveira, A.,

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EMDocs

AUGUST 22, 2024

1 However, we recognize that many patients prefer to speak a language other than English regardless of their English proficiency, and this does not indicate a deficiency. 9 Less likely to be satisfied with their care and have a lower understanding of their discharge instructions. September 2013. Karliner L, Jacobs E, et al.

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REBEL EM

JANUARY 19, 2023

Previous studies regarding ambulatory management included randomized trials that lacked adequate power, and recently, a 2013 systematic review that, although showed promise in the ambulatory approach, had poor data quality with a high risk of bias. Patients followed up every 1-2 days till day 4. 2003;326(7400):1167-1170.

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Dr. Smith's ECG Blog

APRIL 22, 2022

But these cases show the potential dangers of delayed recognition and treatment of inferior reperfusion Take away 1. ECG’s can be labeled as ‘normal’ by the computer (and confirmed by cardiology) even with diagnostic signs of occlusion or reperfusion References 1. Int J Cardiol 2013 2. JAMA Intern Med 2019 9.

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NAEMSP

JANUARY 5, 2023

1] The Adult Cardiac Arrest ACLS algorithm currently includes epinephrine and either amiodarone or lidocaine as recommended pharmacologic therapies. 1] Table from Hamam et al. 9] Figure from Clemency et al. 1] References 1. One study showed that average time to establish an IV in the prehospital setting was 4.4

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REBEL EM

JULY 18, 2022

2013 Sep;31(9):1389-92. Epub 2013 Jul 30. The NoPAC trial, which was published in 2021,(1) compared TXA to placebo in a large multicenter randomized control trial in the UK which looked at data from 26 emergency departments. PMID: 33612282 Janapala RN, Tran QK, Patel J, Mehta E, Pourmand A. Am J Emerg Med.

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ACEP Now

MARCH 14, 2024

1 percent of tracheostomies. 9 There may be no time in which to perform a CT scan, and as noted above, CTA and laryngoscopy may show no remarkable findings of fistula. 2013:1960-62. 2005;128: 3906-9. 2021;4(30):1-4. 2012;36(6):876-9. It occurs after an estimated 0.1-1 Ann Thorac Cardiovasc Surg.

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Dr. Smith's ECG Blog

AUGUST 3, 2017

There are two main etiologies of ischemic ST-depression: 1) subendocardial ischemia 2) reciprocal to ST-elevation in an opposite wall Here there are distinct R-waves with marked ST-depression throughout most of the precordium. Tips for recognizing Acute Posterior STEMI: 1. References: 1. This can help in confirmation.

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Dr. Smith's ECG Blog

NOVEMBER 28, 2022

Right atrial diastolic collapse is the earliest sign, but the patient needs to have right atrial collapse for at least 1/3 of the cardiac cycle which can be difficult to identify with ultrasound. Beck’s triad only happens all 3 together in approximately 1/3rd of patients. 2013 Sep;26(9):965-1012.e15. doi: 10.1016/j.echo.2013.06.023.

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EMDocs

NOVEMBER 13, 2024

Commonly a monomicrobial infection with gram-negative bacteria like E. Paracentesis is a safe procedure with a low complication rate (< 1%). For the remaining fluid inject 1 mL into a purple top EDTA blood tube for cell count; send 2-3 mL for Gram stain in a red-top tube or sterile urine container. coli (50-90% of cases).

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EMDocs

DECEMBER 18, 2024

Initial vital signs: HR 136 BPM, BP 172/82 mmHg, RR 24, T 37.2C, SpO2 97% RA Physical examination: General: restless, mildly agitated CV: tachycardic, regularly regular, diaphoretic, Abdomen: Soft, NT, ND, intermittently dry heaving Neuro: tremulous in bilateral arms and hands, tongue fasciculations What do you suspect as the diagnosis?

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JEMS

JUNE 23, 2025

1 EMS has always been described as the canary in the coal mine and the tip of the spear simultaneously. 1 Yet, despite its critical function, EMS remains an underfunded outlier in the Medicaid landscape, excluded from mandatory federal benefits, inconsistently reimbursed, and perennially subject to the whims of state fiscal policy.

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EMDocs

NOVEMBER 16, 2024

1-3 Despite its commonality it retains a relatively high rate of complications overall and patients frequently present to the ED for evaluation. 9=11 70% monomicrobial, 25% poly-microbial, 5% culture-negative. 9=11 70% monomicrobial, 25% poly-microbial, 5% culture-negative. 2013 Dec;6(4):350-6. 2020 Sep 30;5(9):558-567.

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JEMS

JUNE 12, 2025

1 Many of these approvals represent entirely new drug classes or treatment approaches. 9 Still, some educators worry that reliance on technology could erode hands-on problem-solving. 8-9 The future of medicine will be digital, personalized, and AI-enabled. References 1. Mercier, E., van de Garde, E.

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JEMS

JULY 2, 2025

References 1. Berg G, Nyberg S, Harrison P, Baumchen J, Gurss E, Hennes E. 2013 Dec;13(12):1801-8. Epub 2013 Jun 29. Barnhard By Roy Danks, DO It’s time to decommission the long spine board. The author wishes the interested reader to know that the commentary provided is written tongue-in-cheek. Prehosp Emerg Care.

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Pediatric EM Morsels

JULY 28, 2023

Rates of type 1 diabetes have increased since the COVID-19 pandemic. Insulin (in Bag #1) is for the Acidosis. 2013 Sep;163(3):761-6. 2010 Dec;1(2):103-20. 2001 Jan 25;344(4):264-9. PubMed] [Read by QxMD] [link] Weiss A, Donnachie E, Beyerlein A, Ziegler A, Bonifacio E. Then we’ve likely got DKA.

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Pediatric EM Morsels

MAY 10, 2024

Chest Pain in Children: Hysteria vs Vigilance Diverse pathology can present as chest pain in children Cardiac 1-9% GI 2-10% Musculoskeletal – 2-20% No Identifiable cause – 21-45% of the time! 2013 Oct;132(4):e1010-7. Pediatr Rev September 2020; 41 (9): 469–480. 2021;13(1):2. Pediatrics. PMID: 24019419.

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Pediatric EM Morsels

AUGUST 9, 2024

Worldwide, congenital syphilis complicates about 1 million pregnancies / year. Foles, 2024 ] In the US, from 2013-2018, cases increased from 362 to 1,306. Usually in 1st week of lif e Copious, white-ish drainage Teeming with spirochetes! gross ) Rash Occurs 1-2 weeks after rhinitis. 2024 Jan 16;17(1):e257694.

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ACEP Now

JUNE 17, 2025

1 The objects we choose to fill a limited space reflect a lot about the lives we lead, the way we think, what we anticipate, and what we prioritize. 2013 Apr 15;87(8):536. Gorchynski J, Karabidian E, Sanchez M. There is significance in the things we carry. Reprinted with permission from Springer Nature. Click to enlarge.)

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