Dr. Smith's ECG Blog

SEPTEMBER 22, 2023

What lowered my confidence in calling ECG #1 a definite OMI — was the finding of somewhat similar-appearing , upright T waves with slight-but-real J-point ST elevation in so many leads ( ie, leads I,II,aVF; V2-thru-V6 ). Once I identified leads V4 and V5 as definitely abnormal — I looked closer at neighboring leads.

OR 131

OR STEMI Coronary 131

Core EM

JANUARY 25, 2024

The definitive treatment of a necrotizing soft tissue infection is surgical debridement and removal of the necrotic tissue. It is a rapidly progressing infection that moves along fascial planes, often evading the immune system. This is a tricky diagnosis that can often be inconspicuous, so clinical gestalt is key. 2014;15(1):111-113.

E-9-1-1 246

E-9-1-1 Emergency Department OR 246

EMDocs

APRIL 25, 2025

Minimize On-Scene Time and Focus on Rapid Transport: Definitive care for traumatic cardiac arrest requires hospital-level interventions ; therefore, providers should avoid unnecessary scene delays and focus on rapid transport while continuing interventions en route. Originally published at The Pediatric EMS Podcast on March 5, 2035.

EMS 98

EMS Emergency Medical Services Epinephrine CPR 98

EMDocs

DECEMBER 1, 2024

typhi infection if treatment is refractory to supportive measures or conventional community-acquired pneumonia antibiotics Treat with atypical bacterial coverage (doxycycline, azithromycin, chloramphenicol, or fluoroquinolones) A 32-year-old woman presents to the ED with a fever and rash after returning from a trip to Southeast Asia. .:

EMS 104

EMS E-9-1-1 OR ED 104

The Skeptics' Guide to EM

DECEMBER 21, 2019

Only then would there be definitive evidence for the efficacy of parachutes. Mathew Reeves is a Professor and Interim Chair of the Department of Epidemiology and Biostatistics at the College of Human Medicine at MSU. Dr. Joshua Reynolds is […] The post SGEM Xtra: NNT – WET or DRI first appeared on The Skeptics Guide to Emergency Medicine.

OR 100

OR ALS ED 100

Pediatric EM Morsels

AUGUST 23, 2024

Concussion – Presentation [ Silverberg, 2023 ] There is no definitive test to diagnose concussion in the ED. It does NOT have structural brain damage visible on standard neuroimaging. In the research setting, abnormalities can be found via functional, blood flow, or metabolic imaging.

Emergency Department 284

Emergency Department OR ED EMS 284

The Skeptics' Guide to EM

SEPTEMBER 21, 2024

This has led to variability in EMS protocols, with some agencies including naloxone in their cardiac arrest protocols while others do not specifically recommend it, highlighting a gap in definitive guidance [6]. Your partner asks if you want to administer naloxone as well. Today’s study looks at the role of naloxone in OHCA.

Naloxone 256

Naloxone NARCAN Overdose CPR 256

EMS 12-Lead

APRIL 9, 2024

Many of the changes seen are reminiscent of LVH with “strain,” and downstream Echo may very well corroborate such a suspicion, but since the ECG isn’t the best tool for definitively establishing the presence of LVH, we must favor a subendocardial ischemia pattern, instead. He awoke earlier that morning in his usual state of health.

Coronary 290

Coronary ACS CAD ED 290

REBEL EM

NOVEMBER 6, 2024

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 (..)

E-9-1-1 115

E-9-1-1 ACS OR Emergency Department 115

Core EM

JULY 23, 2024

Hosts: Jonathan Kobles, MD Brian Gilberti, MD [link] Download Leave a Comment Tags: Agitation , psychiatry , Toxicology Show Notes Background/Epidemiology • Definition and Scope : Agitation encompasses behaviors from restlessness to severe altered mental states. IV/IM Regimens : • Medications : Droperidol, haloperidol, midazolam, ketamine.

Emergency Department 233

Emergency Department OR 233

Core EM

JANUARY 25, 2024

Differentiating between the two is difficult as multiple proposed diagnostic criteria have yet to demonstrate sufficient sensitivity or specificity for a definitive diagnosis. The differential diagnosis for this patient includes Ventricular Tachycardia (VT) and Supraventricular Tachycardia (SVT) with aberrancy. Brady WJ, Skiles J.

Coronary 246

Coronary Emergency Department ED OR 246

High Performance EMS

AUGUST 9, 2024

No matter how you decide to distinguish the priority of each request, it is triaged to standardize the rules for a consistent response definition. A brief delay on the low-priority call to obtain an appropriate match should not impact the immediate outcome or, potentially more importantly, the results of the next serious one.

BLS 264

BLS CAD Advanced Life Support Life Support 264

Pediatric EM Morsels

JULY 19, 2024

The definitions, typical healing course, timing of bleed, indications for tonsillectomy and the procedure itself have not changed much since our original morsel. Your support staff…depending on the amount of bleeding, you are about to have your hands full and may need IV access, medications, airway management, etc. Get IV access!

E-9-1-1 293

E-9-1-1 Epinephrine Emergency Department OR 293

Pediatric EM Morsels

SEPTEMBER 22, 2023

Definition A series of hemodynamic changes related to autonomic denervation and loss of sympathetic tone. Spinal shock is a phenomenon of transient, physiologic (rather than anatomic) complete loss of spinal cord function inferior to an injury. Refers to the Spinal Cord Function and Reflexes, not specifically hemodynamic issues.

E-9-1-1 307

E-9-1-1 Epinephrine ALS EMS 307

EMDocs

NOVEMBER 6, 2023

Author: Brit Long, MD (@long_brit) // Reviewed by Alex Koyfman, MD (@EMHighAK) The American Heart Association 2023 Guideline for managing cardiac arrest or life-threatening toxicity due to poisoning was recently released. This post will focus on the key parts of the guideline that affect ED evaluation and management. Top 10 Take Home Pearls 1.

Naloxone 115

Naloxone OR BLS Overdose 115

Dr. Smith's ECG Blog

NOVEMBER 29, 2023

Smith : this ECG is definitely not OMI, but could be mistaken for Swirl pattern, which is a septal OMI with STE in V1 and STD in V6. This new ECG was still interpreted as STEMI and the patient was taken to the cath lab where the angiogram showed completely normal coronary arteries throughout. Unfortunately no echo was available.

OR 126

OR STEMI EMS ED 126

The Skeptics' Guide to EM

DECEMBER 7, 2019

Most of the definition is in the name itself. * The name was not reassuring and the definition was vague. The Journal of Pediatrics published a systematic review of literature regarding the Management of ALTE in 2013 and one of the findings was that there was very little agreement in the literature on how to apply the definition.

CPR 130

CPR ALS OR 130

Critical Care Scenarios

SEPTEMBER 18, 2024

“Definitive” TRALI (there is no longer a less definite category) is defined as: * No evidence of lung injury prior to transfusion * Onset within 6 hours after end of transfusion * P/F ratio <300 or SaO2 <92% on room air * Radiographic evidence of bilateral infiltrates with n.

OR 152

OR 152

ACEP Now

JULY 7, 2023

17,18 Given this, the advent of extracorporeal membrane oxygenation (ECMO) presents an opportunity to bridge care between traditional resuscitation of refractory VF patients in the ED and more definitive management in the catheterization lab. Out-of-hospital cardiac arrest is a commonly encountered entity in U.S. amiodarone or lidocaine).

Defibrillator 98

Defibrillator OR ALS Epinephrine 98

Pediatric EM Morsels

JUNE 7, 2024

Difficult vs. Severe Asthma: Definition and Limits of Asthma Control in the Pediatric Population. Single Maintenance And Reliever Therapy) This intelligent treatment regimen is with an ICS and a Long Acting Beta Agonist (LABA) [formoterol] given both for daily and rescue therapy. Moral of the Morsel Are they controlled? Prevention is key!

Emergency Department 210

Emergency Department OR EMS 210

Don't Forget the Bubbles

JUNE 19, 2023

However, there are no agreed-upon definitions for growth restriction, and there are significant knowledge gaps. Refer to your local or national guidelines to decide whether a patient is SGA or not, but remember that, depending on which definition is used, both over- and underdiagnosis can occur.

ALS 143

ALS OR 143

FOAMfrat

JANUARY 21, 2025

Identifying ECMO Candidates Early ECMO can serve as a vital bridge to definitive treatment for patients in cardiac arrest, especially those with shockable rhythms such as ventricular fibrillation (V-Fib) or ventricular tachycardia (V-Tach). In this episode, Alec Wilcox & I discuss ECPR eligibility & preparation. link] Kopra, J.,

CPR 98

CPR OR 98

Emergency Medicine Cases

JUNE 29, 2021

Was CRASH-2 enough to be definitive, or does the classic EBM mantra of "we need more studies" remain true? Ken Milne of the The SGEM, Anton and Justin look at all the various potential indications for TXA and review the available evidence. Should we be using TXA for epistaxis, postpartum hemorrhage, hyphema or hemoptysis?

OR 130

OR EMS 130

First 10 EM

OCTOBER 21, 2024

Let’s see if I can get myself cancelled by a group of physicians that are definitely smarter than me.) I love toxicologists, but it’s time for someone to call them out. (I I also love ranting. I am sick of the anti-science rhetoric.

OR 120

OR 120

ALiEM

SEPTEMBER 29, 2023

In cases where the nature of the missile is known, plain films or POCUS may be a reasonable first step, but CT imaging would be definitive. A 49-year-old male was triaged to the Fast Track area with complaints of an abrasion to the neck following an assault. He now presents requesting “Neosporin.”

ALS 177

ALS OR 177

Core EM

NOVEMBER 1, 2023

We discuss Electrical Storm (VT storm) and how to care for the very irritable heart. Monomorphic vs polymorphic (Torsades) may change management Wide QRS Fusion best Capture beats Concordance AV-dissociation Lab tests: Potassium, magnesium, troponins, TFTs, etc.

OR 130

OR 130

The Skeptics' Guide to EM

DECEMBER 9, 2023

SGEM listeners are probably familiar with the placebo effect, but can you give us a brief definition or description? Thanks for appraising OPAL and for engaging with me about it. There were lots of varied responses to OPAL. Most were positive and interested.

ALS 200

ALS OR 200

Broome Docs

JANUARY 27, 2025

These results are not definitive, but considering the rarity of demyelination, and the magnitude of the mortality results, this should probably influence clinical practice until we get the proper RCTs. Welcome to the first episode of the Broomedocs podcast for 2025. Listen in and learn! WOMAN are so negative WOMAN-2 Trial Collaborators.

ED 100

ED OR ACS Critical Care 100

Dr. Smith's ECG Blog

MAY 7, 2024

My response: "Definitely not polymorphic VT. Definitely atrial fibrillation. Here is the post cardioversion ECG: Definite pre-excitation (delta waves due to accessory pathway, "bypass tract"). Here is his presenting ECG, which was sent to me real time, along with the 2nd ECG below: Regular Narrow Fast without P-waves.

ALS 131

ALS OR 131

ALiEM

DECEMBER 18, 2023

The regiSCAR diagnostic criteria is the most used diagnostic criteria and is based on a scoring system for possible, probable, or definite diagnosis. Of note, she reported that her dose of lamotrigine has been slowly uptitrated, most recently two days prior changing from 50 mg BID to 75 mg BID. Additional Images Physical Exam Vitals : T 39.6°C;

Emergency Department 177

Emergency Department OR 177

First 10 EM

SEPTEMBER 23, 2024

I definitely talk to people about smoking, but aside from brief counseling and occasionally prescribing nicotine replacement for […] The post Smoking cessation in the emergency department (The COSTED trial) appeared first on First10EM.

Emergency Department 108

Emergency Department OR EMS 108

Emergency Medicine Cases

JANUARY 4, 2022

What are the best strategies to efficiently get the patient in cardiogenic shock to definitive care, whether that be the cath lab or the operating room? How can we best pick up occult cardiogenic shock before it floured shock kicks in?

Operating Room 130

Operating Room OR EMS 130

EMS 12-Lead

APRIL 2, 2022

1, 2] The most clinically useful definition to account for this entire constellation is intraventricular conduction delay. Upon arrival he was found alert and oriented, and without gross distress. He denied difficulty breathing, epigastric pain, or chest discomfort. He denied any chest discomfort, or difficulty breathing. Figure 1-2.

ALS 130

ALS STEMI Coronary OR 130

Core EM

OCTOBER 16, 2024

Author: Natalie Bertrand, MD Editor: Naillid Felipe, MD Background: Definition: adverse reaction to blood product administration Incidence: more common in children than adults, except for delayed hemolytic transfusion reactions Allergic (non-anaphylaxis) – Platelets 1-3%; RBCs 0.1-0.3%

Allergic Reaction 188

Allergic Reaction Plasma ED Epinephrine 188

Dr. Smith's ECG Blog

SEPTEMBER 8, 2023

Chest lead findings in ECG #2 are are more pronounced than they were in ECG #1 — with now definite straightening of the ST segment in lead V2 — as well as ST flattening and depression now clearly seen in lead V3. This is diagnostic of Occlusion MI of the high lateral wall, either from circumflex or first diagonal.

OR 130

OR STEMI Coronary Emergency Department 130

Emergency Medicine Ireland

SEPTEMBER 30, 2024

As a reminder of the basics which I of course knew implicitly and definitely did not have to resort to wikipedia to check… Chyle is largely formed in the small intestine as the gut transports free fatty acids from the intestinal lumen. Today we look at quite a niche topic, that of chylothorax. PN is naturally an option here.

Critical Care 98

Critical Care OR 98

ALiEM

DECEMBER 22, 2023

Occult fractures can be missed on X-rays and CT scans, delaying definitive treatment. The patient stated that upon getting out of bed, she took 4-5 steps, lost her balance, and fell backward onto the bedroom floor. She denied loss of consciousness. She denied syncope or vertigo before the fall. Additional Images Physical Exam Vitals : 37.8°C;

OR 161

OR 161