Don't Forget the Bubbles

AUGUST 3, 2025

You will find the list is broken down into four sections: 1.Reviews Efrem E, et al. 2025 Jul 9:e2024069024. 2025 Jul 9. Arch Dis Child Fetal Neonatal Ed. 2025 Jul 9:fetalneonatal-2025-328635. 2025 Jul 9. Arch Dis Child Fetal Neonatal Ed. 2025 Jul 1:e2024070484. 2025 Jul 1:e2024068886.

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EMDocs

JUNE 28, 2025

Vital signs revealed a BP of 136/76, HR of 88, RR of 9, SpO2 of 94% on room air, and a temperature of 97.6 Answer : Bradypnea Background: Bradypnea is defined as a decreased respiratory rate and varies by age (Table 1) 1 Hypopnea is shallow breathing that occurs during sleep 2 Etiology: Secondary to a number of causes.

EMS

EMDocs

MAY 17, 2025

Case: A 32-year-old female presents to the ED with chief complaint of abdominal pain. 1 These values can be difficult to quickly assess and measure in a fast-paced clinical scenario. See Figure 1. 9 Current best practice suggests a 1:1:1 administration of PRBC, Platelets, and FFP.

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EMDocs

MARCH 24, 2025

The syphilis and trichomonas tests come back negative in the ED, but his rapid HIV test is positive. How should clinicians approach the diagnosis and management of HIV in the ED? 9 Historically, the management of HIV and its complications was primarily the domain of primary care and infectious disease (ID) specialists.

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Dr. Smith's ECG Blog

JANUARY 16, 2020

A man in his early sixties with palpitations An elderly patient with a fall, QS-waves, and ST E. A 20-something woman with Chest Pain Eric Abrams case A woman in her 50s with dyspnea and bradycardia Where is the focus of this tachycardia? Ventricular Fibrillation, ROSC after perfusion res. This middle-aged patient presented with SOB, weakn.

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Dr. Smith's ECG Blog

DECEMBER 27, 2023

Written by Willy Frick A man in his 50s with a history of hypertension, dyslipidemia, type 2 diabetes mellitus, and prior inferior OMI status post DES to his proximal RCA 3 years prior presented to the emergency department at around 3 AM complaining of chest pain onset around 9 PM the evening prior. ECG 1 What do you think? Grines, C.

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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

NOVEMBER 14, 2023

Here is the first ED ECG recorded, now pain free after sublingual Nitro: There is what appears to be a reperfusion T-wave in I and aVL. Learning Point: 1. For examples of such exceptions — See My Comment in the January 9, 2019 — August 22, 2020 — and June 30, 2023 posts in Dr. Smith's ECG Blog ).

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Dr. Smith's ECG Blog

NOVEMBER 15, 2023

[link] Case continued She arrived in the ED and here is the first ED ECG. Angiogram No obstructive epicardial coronary artery disease Cannot exclude non-ACS causes of troponin elevation including coronary vasospasm, stress cardiomyopathy, microvascular disease, etc. IMPRESSION: 1. The Queen no longer thinks it is OMI.

Coronary

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. Despite not being considered in this category, opioid medications are sometimes given for ACS. Am Heart J.

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Dr. Smith's ECG Blog

MARCH 1, 2023

Sent by anonymous, written by Pendell Meyers A man in his late 40s presented to the ED with concern for allergic reaction after accidentally eating a potential allergen, then developing an itchy full body rash and diarrhea. In the ED he received methylprednisolone, diphenhydramine, and epinephrine for possible anaphylaxis.

Allergic Reaction

Dr. Smith's ECG Blog

DECEMBER 13, 2019

Written by Pendell Meyers A man in his late 40s with several ACS risk factors presented with a chief complaint of chest pain. On review of systems the patient reported back pain for approximately 1 week which he was treating with NSAIDs with minimal relief. 15-9/6/2017 ). His first troponin T then resulted elevated at 0.19

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Dr. Smith's ECG Blog

FEBRUARY 16, 2019

mm in just one lead V7-9), but as far as I can tell all of these documents specifically avoid calling this condition STEMI and specifically avoid using any terminology similar to "STEMI equivalent." I focus My Comments on 3 of the ECGs that were shown in this case ( Figure-1 ). This was interpreted as "no significant change."

STEMI

Dr. Smith's ECG Blog

NOVEMBER 30, 2022

The fire department, who operate at an EMT level in this municipality, arrived before us and administered 324 mg of baby aspirin to the patient due to concern for ACS. mm of ST segment elevation, V2 and V3 have 1 mm of elevation, v4 has 2 mm of elevation and v5 around 1.5 Learning Points: 1. What do you think? V1 has 0.5

Emergency Department

ACEP Now

NOVEMBER 7, 2023

A 67-year-old man presents to the emergency department (ED) in cardiac arrest. On ED presentation, he is unresponsive and the monitor shows ventricular fibrillation. 2018;13(9):e0204169. Margey R, Browne L, Murphy E, et al. Emmerson AC, Whitbread M, Fothergill RT. Cortez E, Krebs W, Davis J, et al.

Defibrillator

Dr. Smith's ECG Blog

JULY 30, 2023

The ED physician read this as "Normal sinus rhythm. Obvious STEMI(+) OMI of inferior, posterior, and lateral walls, now with likely 2nd degree heart block type 1 (Wenckebach). STD maximal in V1-V4, without a QRS abnormality causing it, and in the setting of ACS symptoms, is posterior OMI until proven otherwise. Easy for anyone.

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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.

STEMI

ALiEM

FEBRUARY 9, 2024

The 2022 American College of Cardiology (ACC) pathway provides timely guidance [1]. Encourage your ED to set up an algorithm that you can follow based on your laboratory’s assay. Low-risk patients do not routinely require stress testing in the ED. We help you translate this to your clinical practice, by illustrating with a case.

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Dr. Smith's ECG Blog

DECEMBER 11, 2023

The neighbor recorded a systolic blood pressure again above 200 mm Hg and advised her to come to the ED to address her symptoms. 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. At midnight.

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EMDocs

MAY 15, 2024

Today on the emDOCs cast with Brit Long, MD ( @long_brit) , we cover acute chest syndrome part 1. Episode 100: Acute Chest Syndrome Part 1 Background SCD is an autosomal recessive condition that results in the formation of hemoglobin S (HbS). Each episode of ACS has a 9% mortality rate. pneumoniae, C. pneumoniae, C.

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EMDocs

MAY 28, 2024

Sickling leads to vascular occlusion, end-organ ischemia, and decreased RBC lifespan, which, in turn, leads to pain crisis, acute anemia, sequestration, infection, and acute chest syndrome (ACS). ACS is lung injury due to vaso-occlusion in the pulmonary vasculature; many with ACS will have a concomitant vaso-occlusive pain crisis.

ACS

Don't Forget the Bubbles

JULY 22, 2024

Pre-school wheezers remain a poorly understood cohort of children despite seeing them every day in paediatric EDs. However, there was no difference in LOS (83 minutes for placebo vs 79 minutes for prednisolone) in participants who were discharged straight from the ED ( 32% ). study from 200 9. What does it mean to our patients?

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Dr. Smith's ECG Blog

JUNE 17, 2024

Pain improved to 1/10 after EMS administers 324 mg aspirin and the following EKG is obtained at triage. C Examination notable for diaphoresis, 1+ bilateral lower extremity edema, regular heart rate and rhythm, and no signs of respiratory distress with normal breath sounds. looked at consecutive patients with PE, ACS, or neither.

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Don't Forget the Bubbles

JUNE 30, 2023

He has already climbed Ben Nevis in Scotland, visited the Gobi desert (possibly from the comfort of his parents 4 x 4, but who’s judging) and has his bronze D of E nailed. All you know, back in ED, is that the ETA is 10 minutes, and there is a single stab wound to the chest. A PEM Adventure Ranulf is a 14-year-old explorer.

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EMDocs

OCTOBER 8, 2024

Episode 108: Unexplained Sinus Tachycardia Mental Model Background: When a patient in the ED has sinus tachycardia our job as emergency physicians is to identify and treat of the underlying pathology. Discharging a patient with abnormal vital signs has been linked to unanticipated death (1-4). 2005;2(1):44-52. Clin Cardiol.

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Dr. Smith's ECG Blog

NOVEMBER 12, 2020

This is a 30-something healthy patient presented with COVID pneumonia who presented to the ED. Here they are: Learning Points: 1. Type 1 and 2 Myocardial Infarction and Myocardial Injury: Clinical Transition to High-Sensitivity Cardiac Troponin I. Am J Med [Internet] 2017;130(12):1431–9.e4. He was moderately hypoxic.

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AAEM RSA

DECEMBER 3, 2020

1 His description of cases of life-threatening infections in the perineal, genital or perianal regions were thought to be idiopathic in previously healthy men. 3-5 Fournier gangrene is a type of necrotizing soft tissue infection, which can be categorized into four types based on the infectious organism involved and other features (Table 1).

Emergency Department

ACEP Now

NOVEMBER 14, 2023

One of the most hair-raising presentations to the emergency department (ED) can be massive hemoptysis with respiratory failure. or 9 size endotracheal tube to allow for bronchoscopy and/or endobronchial blocker placement whenever necessary. These patients are at imminent risk of respiratory failure. A special thanks to Drs.

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AAEM RSA

APRIL 1, 2021

1 The American College of Surgeons’ (ACS) Trauma Quality Improvement Program (TQIP) Massive Transfusion in Trauma Guidelines leave a good amount of flexibility for hospitals regarding transfusion protocols, focusing more on systems-level aspects of designing and implementing MTPs.2,3 in the 1:1:1 group vs. 17.0%

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EMDocs

NOVEMBER 4, 2024

Jafar Mahmood, MD (Pain Medicine Attending, Paincare Medical Practice) // Reviewed by: Jessica Pelletier, DO, MHPE (EM Attending, APD, University of Missouri-Columbia), Marina Boushra, MD (EM-CCM Attending, Cleveland Clinic); Brit Long, MD (@long_brit) Introduction: Pain management in the ED can be a unique challenge.

ED

EMDocs

FEBRUARY 12, 2024

As the only respiratory therapist in the ED has been paged and is starting BiPAP for this patient, an overhead call for two incoming trauma alerts from a multivehicle collision sounds. Importantly, the comparison between an ABG and VBG is site-specific, as illustrated below (Table 1) (1, 3-6).

Emergency Department

EMDocs

JANUARY 20, 2024

She describes the pain as left-sided, non-radiating, and 9/10 in severity. Answer: Takotsubo Cardiomyopathy 1-18 Background: Also known as transient apical ballooning syndrome, apical ballooning cardiomyopathy, stress-induced cardiomyopathy, stress cardiomyopathy, Gebrochenes-Herz syndrome, and broken-heart syndrome.

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EMDocs

JANUARY 6, 2024

A 64-year-old male presents by EMS to the ED with shortness of breath. 1 There are over 50,000 visits related to heart transplant in the United States each year and over half of these patients are admitted to the hospital from the ED. We’ll keep it short, while you keep that EM brain sharp.

EMS

Dr. Smith's ECG Blog

APRIL 8, 2015

Summary of ED Approach to Syncope Please excuse the formatting problems, which I have not been able to fix! Cardiac Syncope ("True Syncope") Independent Predictors of Adverse Outcomes condensed from multiple studies 1. Palpitations preceding syncope (highest value on EGSYS score) 9. Abnormal ECG – looks for cardiac syncope.

Emergency Department

EMDocs

JUNE 14, 2023

Patellar reflexes are 1+. 1, 2, 4, 9 Organophosphates are one of many types of insecticide and are used worldwide to manage crops. 1, 2 Symmetric sensorimotor axonopathy: leg cramping to extremity weakness and paralysis. 1, 2 Sensory > Motor neurons with predilection for long axons. Muscle tone is normal.

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EMDocs

JUNE 27, 2024

An 8-year old male with a history of sickle cell anemia presents to the ED for evaluation of fever for 2 days and “feeling like I can’t get a full breath”. 2 mcg/kg, max 100 mcg) while obtaining IV access 20 IV/IM ketorolac (1 mg/kg, max 15 mg) Morphine (05-0.1 C or 100.4 mg/kg, max 4 mg per dose q20-30min) or hydromorphone (0.01-0.02

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EMDocs

JUNE 7, 2023

F, HR 48, RR 28, BP 104/62, SPO2 88% on non-rebreather mask The patient’s friend who brought her to the ED tells you the patient made suicidal statements earlier in the day and was found in her yard shed. 1-5 Farmers also treat sheep for parasites using OPs and may become symptomatic after exposure, an illness called Dipper’s Flu.

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