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In Figure-1 is the ECG from the August 26, 2009 post in Dr. Smith's ECG Blog ( this being one of the 10 Cases of Inferior HATWs that Dr. Smith links to — and the ECG for which he gives a preview of the HATW model that he and Dr. Meyers are working on ). Figure-1: ECG from the August 26, 2009 post in Dr. Smith's ECG Blog.
Findings: No significant difference […] The post Intraosseous or Intravenous Vascular Access for Out-of-Hospital Cardiac Arrest appeared first on EMOttawa Blog. IV vascular access in adults with OHCA, using ROSC as a primary outcome.
T-waves are quite tall and possibly peaked (HyperK?), but potassium returned normal. I do not see OMI here and all trops were only minimally elevated, consistent with either chronic injury from cardiomyopathy or with acute injury from sepsis. What is the QT interval? In LBBB, the QT interval is partly prolonged by the wide QRS. Bogossian et al. (1)
Because the articles and advice found within contain such critical subject matter, we've elected to publish each segment one at a time here on our blog. Editor's Note: In August 2024, EMS1 and Fitch & Associates released their annual EMS trend survey, What Paramedics Want, proudly sponsored by Pulsara.
Elbow Dislocation Definition: Disarticulation of the proximal radius & ulna bones from the humerus Epidemiology: Incidence Second most common joint dislocation (after shoulder) in adults Most commonly dislocated joint in children Accounts for 10-25% of all injuries to the elbow ( Cohen 1998 ) Posterolateral is the most common type of dislocation (..)
Skip to content Twitter Google+ Facebook Reddit RSS The Bottom Line A compendium of critical appraisals in Intensive Care Medicine research and related specialties Home About Us Summaries Intensive Care Medicine Emergency Medicine Peri-operative Medicine Blog News EBM Editorial Submit a review Wessex ICS You are here: Home Blog Emergency Evidence Updates (..)
Both studies demonstrated no difference in their primary outcome of mortality before discharge home by day 90 when employing a ‘liberal’ or ‘restrictive’ approach to fluid resuscitation for patients in septic shock. LVOT VTI is particularly helpful in managing septic patients because it offers a reliable way to evaluate fluid responsiveness.
As I emphasize in My Comment in the June 1, 2022 post in Dr. Smith's ECG Blog — such "T wave imbalance" is a nonspecific finding that I have on occasion found useful as a "tip-off" to an acute coronary syndrome that I might not otherwise have recognized. Another EKG was also obtained. That alone is enough to activate the cath lab.
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.
Findings: There was no significant difference in reduction of pain scores or adverse […] The post Out-of-Hospital Intranasal Ketamine as an Adjunct to Fentanyl for the Treatment of Acute Traumatic Pain: A Randomized Clinical Trial appeared first on EMOttawa Blog.
Unfortunately, this last rule of the original Sgarbossa criteria didn’t perform as well as the first two and Dr. Stephen Smith, of Dr. Smith’s ECG blog, modified that rule, and his modification has replaced the original rule. Final read: This is normal sinus rhythm with a left bundle branch block. Enter the Sgarbossa Criteria.
appeared first on REBEL EM - Emergency Medicine Blog. Bottom Line Up Top: There doesnt appear to be a morbidity or mortality benefit to treating fever in sepsis and fever may have a protective effect. Only treat fever if it causes the patient distress. Clinical Scenario: A 45-year-old woman presents with cough and shortness of breath.
But even accounting for that, early epinephrine showed no association with improved outcomes : Early epinephrine was not associated with survival to discharge (aRR 0.97, 95% CI 0.82, 1.14) or survival with favorable neurologic outcome (aRR 0.99, 95% CI 0.82, 1.18).
On your blog I appreciate the QOH ECGs that highlight where the QOH is looking. I am still working to better identify OIM / NOIM and use the Queen of Hearts as a tool. In this case I was confident in my assessment of hyperacute T waves and STD for OMI and used QOH to confirm it. Thank you so much for your time and feedback on this case.
In 2018, Meyers, Weingart, and Smith published “The OMI Manifesto” which shed light on the concept of a novel categorization of acute myocardial infarction 2. Classically, the presence or absence of ST elevation on the ECG dictated the need for cardiac intervention. Non-occlusive MI would tend to be managed medically. A recent study by Palladino et.
CEU Pre-Hospital *Military Discounts Available* View Course Dates The post Levitan/Rezaie Practical Airway Course appeared first on REBEL EM - Emergency Medicine Blog. Levitan and Dr. Rezaie on crisis performance, oxygenation, airway anatomy, laryngoscopy, endoscopy, pediatrics, rescue oxygenation techniques and critical care.
A Simple Approach to Sinus Tachycardia appeared first on REBEL EM - Emergency Medicine Blog. 🧭 REBEL Rundown 📌 Key Points 🩺 Sinus Tachycardia = Clinical Clue: Don’t just treat the number—it’s a sign of underlying physiologic stress. Cardiovascular Read More The post REBEL Core Cast 137.0:
interesting spontaneous reperfusion case 1413140 prehospital STEMI first ED ECG is here, with 3/10 pain: But this is the same patient just 10 minutes before, with 7/10 pain Isn't it ridiculous to say that the patient has both a STEMI and an NSTEMI? ACS is dynamic. It can't be given one static name.
Then numerous angiographic studies refuted this and showed that it is almost always due to posterior STEMI. There are exceptions to this and in most cases the patient has reason for demand ischemia - hypotension and/or tachycardia - AND the ST depression is diffuse, including the precordium]. This is usually accompanied by ST elevation in V1.
EMCrit Blog The Necessity of Emergency Reflex Action Drills EMCrit RACC Podcast 220 – Beat the Stress Fool (BtSF) with Mike Lauria — Just In Time Performance-Enhancing Psychological Skills. difficulty with tools like central line wire) Attention narrowing (tunnel vision, auditory exclusion) Time distortion (e.g., How do I set it up?”)
The heterogeneity of treatment effects was also assessed among different hemoglobin SS genotypes, levels of care, volumes of fluid resuscitation, and diagnosis of acute kidney dysfunction on admission. Outcomes: Primary and secondary outcomes were objective and patient-centered but not optimally measured.
Check out the three previous ESO Updates Quarterly Product Enhancements blog posts below. “Training Sessions and Duration by Personnel” is a global dashboard for customers who do not use credit hours and points for training classes and would prefer to calculate and record time based on session length. What to expect in Q1/25?
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. The de Winter electrocardiogram pattern is an infrequent presentation, reported to occur in 2% to 3.4% of patients with anterior myocardial infarction ( 1 ).
EMCrit Blog. EMCrit 404 – Facial Trauma. Published on July 19, 2025. Accessed on July 20th 2025. Available at [[link] ]. Financial Disclosures: The course director, Dr. Scott D. Weingart MD FCCM, reports no relevant financial relationships with ineligible companies. As a member, you can.
Checklist for Treatment of Local Anesthetic Systemic Toxicity: ASRA Pain Medicina November 1.2020 Available at: [link] publications/asra-updates/blog-landing/guidelines/2020/11/01 Ashacklist for-treatment-of-loc-anesthetic-systemic-toxicity Accessed 30, 2025. major LAST events (cardiac arrest or seizures) per 1,000 peripheral nerve blocks.
Full blog post here. Welcome to the first episode of the Broomedocs podcast for 2025. Justin and I are back for more nerdy goodness to make you smarter in the Resus room, or at a pub trivia night more likley… wether it is about salt correction, dissection or infection we can help you out! Listen in and learn! Emerg Med J.
Registered at PROSPERO (CRD42023403212) Population: Inclusion criteria: Adult intubation using a bougie as an intervention compared to usual care (intubation with or without a stylet). Intubation performed in all settings (out-of-hospital, emergency department, ICU, and operating room). Exclusion criteria: Manikin and cadaver studies. airway scope).
Essentially, to put this blog to rest You will treat the patient the same as any other patient. Let's start with a: Quick Terminology Refresher Mechanical Circulatory Support Device (MCS): General term for any device that aids the heart, whether temporarily or permanently. So does this mean we cannot obtain a blood pressure?
Background: Patients with sepsis are routinely treated with empiric broad-spectrum antibiotics while awaiting source identification, as recommended by the surviving sepsis campaign.2 2 Vancomycin, in combination with either piperacillin-tazobactam or cefepime, is commonly used for empiric treatment in these cases. In 2021, Buckley et.
History of Present Illness The collateral history indicates that her symptoms began one week into her journey, but medical care was inaccessible at the time. The family reports no history of food allergies, insect bites, or contact with sick individuals. The patient did not receive pre-travel prophylaxis for malaria, hepatitis A, or yellow fever.
Read the blog or watch the video to get the full story. To read more on the product innovations and research that made us most proud, check out the blog posts below. By focusing on preventive care and data-driven insights, the agency is lowering costs and improving outcomes.
Translate Follow us on X (Twitter) Follow @smithECGBlog Follow @PendellM Follow @ekgpress Follow @AslangerE Follow @ecgcases Follow @PMcardioBot Total Pageviews Use this Blog as a Textbook I highly recommend using this blog as an atlas or textbook. The QRS proves it. Posted by Steve Smith at 6:29 AM Email This BlogThis!
Rezaie, MD (Twitter/X: @srrezaie ) The post REBEL Core Cast 131.0 – Traumatic Arthrotomy appeared first on REBEL EM - Emergency Medicine Blog. Saline load test Has mainly been supplanted by CT scan due to ease in obtaining, reported performance characteristics, consultant recommendation and difficulty in interpreting test.
An elderly man with a history of diabetes and HTN presented with lethargy and weakness. He had no CP or SOB, and it was unknown if there was a previous history of atrial fib. He was on atenolol, but it was not known if this was simply for hypertension, or for atrial fib. He was not anticoagulated. He also had decreased urine output. What to do?
Obtaining peripheral ultrasound guided IV access is not only a core […] The post Ultrasound Guided Peripheral IVs appeared first on EMOttawa Blog. Do you spend 20 minutes performing an invasive central line? Does your resident finally get two IO EPAs? Or do you save the day with a slick, ultrasound guided IV?
Brief ischemia with pain might not lead to troponin elevation. For such patients, it can be useful to use "Risk Scores" such as HEART or EDACS. I prefer EDACS for many reasons: 1. Age is in 5 year increments. With HEART score, age of 46 = 64, and that is absurd. If either are "positive," the patient needs further evaluation.
Skip to content Twitter Google+ Facebook Reddit RSS The Bottom Line A compendium of critical appraisals in Intensive Care Medicine research and related specialties Home About Us Summaries Intensive Care Medicine Emergency Medicine Peri-operative Medicine Blog News EBM Editorial Submit a review Wessex ICS You are here: Home Blog Critical Care Evidence (..)
I started this blog over 20 years ago. At the time I wrote mainly about the interesting calls I was doing. Nowadays, besides writing about the opioid epidemic, it seems I write mostly about being an old medic trying to keep up, beating back father time. This is another one of those posts. I worked a 12-hour shift last Friday.
A 60 yo with no cardiopulmonary history, felt dizzy, cold and clammy, and then had syncope. She denied SOB or Chest pain. Pulse oximetry was 95%. Lung and heart exams were normal. A bedside echo done by an ultrasound-fellowship-trained EP was recorded as normal. And such absence may or may not lead one to pursue other diagnoses. Great Question.
The patient may have been experiencing episodes of polymorphic VT. Type 1 Brugada syndrome requires, in addition to clinical criteria, a classic "coved" type ST elevation in leads V1 and/or V2. There should be at least 2 mm of ST elevation at the J-point, and downsloping ST segment, and an inverted T-wave.
This blog post was written to accompany a Simulated PEM Adventure at Neptune 2025, the UK Paediatric Trauma Conference. Let’s be honest: most of us have had moments at work where we’ve felt hurt by something someone has said or done. Healthcare can be high-pressure and emotionally demanding. What are microaggressions?
The Zoll algorithm impressively stated: STEMI A paramedic student had the PMCardio AI Queen of Hearts on his phone and this is what it reported: New PMcardio for Individuals App 3.0 now includes the latest Queen of Hearts model and AI explainability (blue heatmaps)! Download now for iOS or Android. (Dr. Smith is a shareholder in Powerful Medical.)
REBEL Rundown Key Points Generalizability: Mostly Canadian patients with gram-negative UTIs or abdominal infections. Bias: Multiple biases may have made 7 days look better than it is. Margin: Allowed up to 1 in 25 more deathsthough stricter than past trials. Gram-Positive? Still not enough data for other bugs or sources. Community-onset: 75.4%
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