REBEL EM

DECEMBER 17, 2024

The Bottom Line: HEAT Trial Acetaminophen for Fever in critically Ill Patients with Suspected Infection The SGEM: SGEM #146 The Heat is On IV Acetaminophen for Fever in the ICU References Young, P et al. PMID: 26436473 Schortgen F et al. PMID: 22366046 Sunden-Culberg J et al. NEJM 2015; 373(23): 2215-24.

ICU 72

ICU ALS Emergency Department EMS 72

NAEMSP

JULY 15, 2025

Hershey Medical Center Editors : Alex Blau, DO; Michael DeFilippo, DO, Assistant Professor of EM & EMS, WashU School of Medicine Clinical Case The day after a snowstorm you are working for a rural, advanced life support (ALS) agency and you are called to a 62-year-old gentleman with chest pain. A recent study by Palladino et.

EMS 69

EMS Coronary STEMI Advanced Life Support 69

Dr. Smith's ECG Blog

JANUARY 31, 2025

al in 2008, and is eponymously named after the main author. 2020) If you are a regular reader of this blog this diagnosis will be easy for you, and you will manage this type of patient correctly with immediate revascularization. de Winter et al ( N Engl J Med 359:2071-2073, 2008 ). Image reproduced from Kloner, R.A.

STEMI 121

STEMI Coronary ALS OR 121

EMOttawa

MARCH 10, 2025

5 Gibbs KW, et al. Findings:Hypoxemia occurred in 9.1% […] The post Noninvasive Ventilation for Preoxygenation during Emergency Intubation appeared first on EMOttawa Blog. Methodology: 4/5 Usefulness: 3.5/5 N Engl J Med. 2024 Jun 20;390(23):2165-2177.

ALS 91

ALS Critical Care 91

REBEL EM

DECEMBER 23, 2024

To assess the clinical impact and relevance of these concerns, Alwang et al. PMID: 28423290 Kidwell K, Albo C, Pope M, et al. PMID: 24066745 Self WH, Semler MW, Wanderer JP, et al. PMID: 29485926 Semler MW, Self WH, Wanderer JP, et al. PMID: 29485925 Self WH, Evans CS, Jenkins CA, et al. Sickle Cell Disease.

ALS 116

ALS ED ACS EMR 116

Dr. Smith's ECG Blog

SEPTEMBER 6, 2013

mm (presumably in 2 consecutive leads, but this important study by Wung et al in 2001 is vague on that). There is greater than 1 mm of ST in all 3 leads. The standard "criterion" for posterior MI, with about 80% sensitivity andd specificity, is 0.5 So this easily meets criteria for posterior STEMI.

STEMI 52

STEMI OR ALS ED 52

EMDocs

JULY 7, 2025

Just In Time “Just in time” techniques for chaotic moments Trial these during high-stress times: sim lab, busy shifts, real resuscitations Must be practiced to be effective Based on performance psychology in high-stakes environments 4-Step Performance Process (Lauria et al., 5 seconds) Exhale through pursed lips (e.g.,

STEMI 87

STEMI ALS OR EMS 87

ACEP Now

MAY 10, 2025

References Goldsmith A, Driver L, Duggan NM, et al. Newberry MA, et al. Leu N Anderson E et al Safety and Pain Reductiontin Emergency Practitioner Ultrasound-Guided Nerve Blocks: A One-Year Retrospective Study Ann Emerg Med 2024,83(1):14-21. Sandoval MV et al. JAMA Netw Open 2024:7(11)1-2444742. Farrow RA, Shalaby M.

ED 87

ED Emergency Department ALS Epinephrine 87

REBEL EM

NOVEMBER 25, 2024

Paper: von Hellmann R, Fuhr N, Maia IWA, et al. References: Driver BE, Prekker ME, Klein LR, et al. PMID: 29800096 Driver BE et al. PMID: 34879143 Apfelbaum JL, Hagberg CA, Connis RT, et al. PMID: 34762729 von Hellmann R, Fuhr N, Maia IWA, et al. PMID: 37725023 Prekker ME, Driver BE, Trent SA, et al.

Operating Room 92

Operating Room Emergency Department ICU ALS 92

REBEL EM

NOVEMBER 11, 2024

Article: Chanderraj R, Admon AJ, He Y, et al. PMID: 38739397 Evans L, Rhodes A, Alhazzani W, et al. PMID: 34790489 Qian ET, Casey JD, Wright A, et al. PMID: 28856738 Pettigrew MM, Gent JF, Kong Y, Halpin AL, Pineles L, Harris AD, Johnson JK. In 2021, Buckley et. 3 The same year, Ross et. JAMA Intern Med. Pettigrew et.

E-9-1-1 93

E-9-1-1 ICU ALS Critical Care 93

EMDocs

JANUARY 6, 2025

57 Adapted from: Long B, MacDonald A, Liang SY, et al. World Bank Blogs. link] Rother B, Pierre G, Lombardo D, et al. link] Franco JR, Cecchi G, Priotto G, et al. Biggs H, Behravesh CB, Bradley KK et al. doi:10.1136/bmjgh-2018-001114 Okesanya OJ, Olatunji GD, Kokori E, et al. 57 Table 2. 2024;77:7-16.

ED 73

ED E-9-1-1 ALS Frozen Plasma 73

FOAMfrat

DECEMBER 31, 2024

Essentially, to put this blog to rest You will treat the patient the same as any other patient. After reading this awesome paper, we should feel more at ease treating these patients (PMID: 30202496; AHA (Peberdy et al., The clinician would inflate the blood pressure cuff and use the Doppler just as they would with a stethoscope.

CPR 64

CPR Defibrillator Emergency Department Emergency Transportation 64

Broome Docs

JANUARY 27, 2025

Full blog post here. 100% seems too good to be true Morello et al., PMID: 39461792 Bottom line: The WOMAN 2 trial is a large double-blind RCT that shows no benefit of TXA in the prevention of postpartum hemorrhage, which fits with all of the existing literature demonstrating no role for TXA in the management of postpartum hemorrhage.

ED 100

ED OR ACS Critical Care 100

Dr. Smith's ECG Blog

MAY 31, 2014

See this photo of Figure 1 in Wellens' first paper (de Zwann C et al. This is spite of the fact that the T-wave inversions are atypical for Wellens' waves: pattern A has slight ST elevation with upward sloping ST segment, then sudden downward drop; pattern B has deep symmetric T-waves.

Coronary 52

Coronary ACS ALS OR 52

Don't Forget the Bubbles

JULY 15, 2025

This blog post was written to accompany a Simulated PEM Adventure at Neptune 2025, the UK Paediatric Trauma Conference. Available from: [link] Desai V, Hernandez Conte A, Nguyen VT et al. Govindraj R, Binda DD, Harris AC et al. Healthcare can be high-pressure and emotionally demanding. February 2021. Glob Qual Nurs Res.

OR 135

OR ALS ACS 135

REBEL EM

MAY 19, 2025

REBEL Recap References Evans L, Rhodes A, Alhazzani W, et al. PMID: 34605781 Yahav D, Franceschini E, Koppel F, et al. PMID: 30535100 von Dach E, Albrich WC, Brunel AS, et al. PMID: 32484534 Molina J, Montero-Mateos E, Praena-Segovia J, et al. N Engl J Med. 2025;392(11):1065-1078. Crit Care Med. 2021;49(11):e1063e1143.

E-9-1-1 54

E-9-1-1 ICU ALS OR 54

Dr. Smith's ECG Blog

FEBRUARY 4, 2025

From VPS Connolly et al JACC, 1999 ) Major benefit to pacing! From VPS II Connolly et al JAMA, 2003 ) Answer: No significant reduction in syncope!! There was a randomized trial to determine whether pacemakers could benefit patients with vasovagal syncope, aptly named The North American Vasovagal Pacemaker Study (VPS).

ALS 91

ALS OR 91

Dr. Smith's ECG Blog

MAY 20, 2019

Co-culprit is a 85% bifurcating lesion of the large LADD1 related to above LAD lesion This is an important article by Widimsky et al. Therefore, an angiogram was done next day: Culprit is 99% stenosis in the mid LAD near previous stent.

ACS 52

ACS Coronary OR ALS 52

Broome Docs

DECEMBER 22, 2024

You can find more details in the full blog post. PMID: 38959879 This might be the best paper we have ever discussed on the blog/podcast. N Engl J Med. 2024 Oct 31:10.1056/NEJMoa2407780. doi: 10.1056/NEJMoa2407780. Epub ahead of print. Which is better in out of hospital cardiac arrest: IV or IO? 2024 Jul 22;34(14):3273-3278.e3.

E-9-1-1 52

E-9-1-1 ACS Paramedic Emergency Department 52

Dr. Smith's ECG Blog

OCTOBER 7, 2022

Rallidis Et al. By way of review in Figure-2 — I've included the Table that I've shown before in Dr. Smith's ECG Blog of the ECG findings most commonly seen for the 2 most common ECG patterns in patients with Takotsubo CM ( See My Comment in the March 25, 2020 post — as well as the Echo pictures by Dr.

ACS 52

ACS Coronary CAD OR 52

Dr. Smith's ECG Blog

DECEMBER 20, 2024

It should not be surprising that his symptoms were associated with micturition, as atrial tachyarrhythmias are known to produce polyuria ( Kinney et al. Kaye et al. Canepa-Anson et al. The patient was treated with amiodarone which suppressed his atrial tachycardia, and his symptoms resolved.

Defibrillator 107

Defibrillator Coronary ALS Emergency Department 107

REBEL EM

NOVEMBER 21, 2024

Intravenous antibiotics and hospital admission Lumbar puncture and, if results are normal, discharge home with close outpatient follow-up Lumbar puncture, intravenous antibiotics, and hospital admission Oral antibiotics and discharge home with close outpatient follow-up References Pantell RH, Roberts KB, Adams WG, et al. Pediatrics.

ALS 54

ALS ED EMS 54

Dr. Smith's ECG Blog

JUNE 10, 2025

Transient STEMI was studied by Lemkes et al. Lemkes JS, Janssens GN, van der Hoeven NW, et al. Available from: [link] Lemkes et al. This is really a transient OMI (or transient STEMI if one uses that terminology and it has diagnostic ST Elevation). Eur Heart J [Internet] 2019;40(3):283–91.

STEMI 70

STEMI E-9-1-1 CAD ALS 70

Dr. Smith's ECG Blog

JULY 23, 2015

For myself (and I suspect other readers of this blog), however, it affected my perception in exactly the opposite way – it immediately made me suspicious of misdiagnosis and wary of the dangers of diagnosing pericarditis (and therefore missing other diagnoses). There does not seem to be good evidence to answer this question, unfortunately.

STEMI 52

STEMI OR Coronary ED 52

Dr. Smith's ECG Blog

FEBRUARY 10, 2025

Lindner et al. Durfey et al. Farkas et al. The reason this is clinically important is that if hypocalcemia is present, this may further exacerbate the adverse cardiac effects of hyperkalemia ( Barboza de Oliveira et al Rev Bras Cir Cardiovasc 29(3):432-436, 2014 ). References 1. Eur J Emerg Med 2020.

ALS 125

ALS ED ICU OR 125

Dr. Smith's ECG Blog

AUGUST 21, 2019

Recently, Nestelberger et al. There is a 2013 paper by Cai and Sgarbossa that used the Smith modified Sgargossa criteria to create and algorithm for deciding on the cath lab in patients with left bundle branch block. I have posted that algorithm below.

ALS 52

ALS 52

Dr. Smith's ECG Blog

JUNE 6, 2020

Birnbaum et al ( Am Heart J 131:38, 1996 ) — studied the predictive value of ST elevation in lead aVL for this purpose. I summarized the conclusions by Birnbaum et al in My Comment at the bottom of the page in the February 4, 2020 post in Dr. Smith’s ECG Blog.

STEMI 40

STEMI ALS OR 40

REBEL EM

JULY 14, 2025

7 🧾 Paper Cohen A, Reijman M, Kraan GA, et al. PMID: 18656779 Dean BJF, Riley N, Little C, et al. PMID: 26582616 Cohen A, Reijman M, Kraan GA, et al. About 1 in 10 patients will have an occult fracture, and roughly 1 in 10 scaphoid fractures result in nonunion. Can we avoid casting for suspected scaphoid fractures?

E-9-1-1 103

E-9-1-1 ALS OR ED 103

Dr. Smith's ECG Blog

MAY 28, 2025

For this reason I think it is reasonable to classify the presenting diagnosis of the patient in this case as “unstable angina” when we take into account sex AND age-specific hs-cTnT concentration thresholds. Souce: McEvoy, John W., Myocardial injury thresholds for 4 high-sensitivity troponin assays in US adults."

Coronary 59

Coronary ED STEMI Emergency Department 59

REBEL EM

APRIL 28, 2025

Read More LITFL: [link] REBEL EM: [link] References Jain A et al. PMID: 20157454 Menchine M et al. PMID: 21951652 Uysal E et al. PMID: 26658635 Mahmoud H et al. PMID: 35371883 Tang S et al. PMID: 38431760 Triplett KE et al. appeared first on REBEL EM - Emergency Medicine Blog. Nature 2024; 14: 5194.

ALS 84

ALS Emergency Department ICU EMS 84

EMOttawa

JULY 21, 2025

Methodology: 4/5 Usefulness: 3/5 Cohen A, et al. A multicenter randomized controlled trial appeared first on EMOttawa Blog. J Orthop Traumatol. 2025 Mar 5;26(1):14. doi: 10.1186/s10195-025-00822-5. Findings: Bandaging was noninferior to casting for QDASH at 3 months: 8.7

ALS 52

ALS 52

REBEL EM

FEBRUARY 28, 2025

PMID: 25275357 Jain A et al. appeared first on REBEL EM - Emergency Medicine Blog. Additional Resources EMRAP UC Max: The Nail Bed Injury First10EM: The NINJA Trial: Do you replace the fingernail after nail bed repair? References Patel L. Management of simple nail bed lacerations and subungal hematomas in the emergency department.

Emergency Department 50

Emergency Department ED ALS OR 50

REBEL EM

FEBRUARY 24, 2025

Jan 2015; PMID: 25559473 Airapetian N, et al. Di Nicol P, et al. Mar 2023; PMID: 36983218 Feissel M, et al. Sep 2004; PMID: 15045170 Luecke T, et al “PEEP and cardiac output.” ” Anaesthesia, Pain, Intensive Care and Emergency MedicineAPICE: Oct 1005; PMID: 16356246 Bilgili B, et al.

ALS 64

ALS E-9-1-1 Critical Care OR 64

Dr. Smith's ECG Blog

DECEMBER 16, 2024

As noted above the presence of acute target organ damage in today's case ( ie, acute MI ) in association with marked sustained hypertension ( this patient's BP at times exceeding 200 mm Hg systolic and >110 mm Hg diastolic ) qualifies her as a true hypertensive emergency ( Janke et al JAHA 5(12); 2016 and Cardiology Advisor Feb.

STEMI 108

STEMI Coronary Critical Care ED 108

Dr. Smith's ECG Blog

APRIL 4, 2011

65 y old male, hypt, IHD, smoker, central chest pain, was in pulm oedema Killip III Great recent article relevant to this: Kosuge M, Ebina T, Hibi K, et al. An early and simple predictor of severe left main and/or three-vessel disease in patients with non-ST-segment elevation acute coronary syndrome. Am J Cardiol;107(4):495-500.

CAD 52

CAD ACS Coronary ALS 52

REBEL EM

MARCH 31, 2025

References Bannelier H et al. appeared first on REBEL EM - Emergency Medicine Blog. If the patient errantly had a D-Dimer sent and it was negative, a clinician could consider skipping a CTPA, though additional data should be obtained. Acad Emerg Med 2024. PMID: 39487597 REBEL EM: D-Dimer in High Risk PE: A Gamble Worth Taking?

EMS 42

EMS ALS OR ED 42

REBEL EM

JUNE 2, 2025

In: Nelson LS, et al., Available at: [link] Akakpo JY, Ramachandran A, Duan L, et al. PMID: 30903181 Akakpo JY, Ramachandran A, Kandel SE, et al. PMID: 31785979 Kang AM, Padilla-Jones A, Fisher ES, et al. As with all cases of toxicity, please call your local poison control center for assistance. Chapter 33. Acetaminophen.

Overdose 110

Overdose ALS OR ED 110