Dr. Smith's ECG Blog

DECEMBER 29, 2024

The Queen of Hearts also knows which large T-waves are hyperacute and which are not: She knows that it is not OMI (Unfortunately, most providers no longer have access to the Queen of Hearts because 1) it is not yet FDA approved and 2) thus a provider can only use it in the context of research.) Here are 9 cases that involve re-occlusion.

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E-9-1-1 STEMI Critical Care OR 72

JEMS

JULY 3, 2025

1 The author’s employer, a Michigan-based life support agency, further represents clinician shortages, experiencing only a 70% retention rate of EMTs and a 77% retention rate of paramedics. Here’s a closer look at each topic: 1. References 1. Cognitive load. Personality traits affecting career longevity. Blau, G., &

EMS 116

EMS E-9-1-1 EMT EMT 116

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 EMS has always been described as the canary in the coal mine and the tip of the spear simultaneously. 23 This presents several key problems: 1. 2 The “One Big Beautiful Budget Bill,” formally designated H.R.

EMS 116

EMS E-9-1-1 Community Paramedicine Emergency Medical Services 116

JEMS

JULY 23, 2025

2 Only 1% of those studied actively attempted to solicit information from the patient with a suspected Autism Spectrum Disorder (ASD), instead electing to question bystanders. The DSM-5 splits Autism Spectrum Disorder into three levels on this basis: Level 1. References 1. 11 An average lifespan of only 36.2 McCarthy, M.

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E-9-1-1 EMT EMT Public Safety 98

JEMS

JUNE 19, 2025

In 2025, some systems are running 1 EMS call every 45 seconds in urban centers, with the majority of those calls for non-life-threatening issues. 1 Yet the industry response has been predictable; “We need more medics.” Delbridge, TR, Davis, CD, Atkins, DL, Castillo, EM, Clawson, J, Goralnick, E, … & Swor, R.

Paramedic 138

Paramedic Mobile Integrated Health E-9-1-1 Emergency Medical Services 138

JEMS

JUNE 23, 2025

Patients can lose up to 2 million brain cells every minute of a stroke; every hour without treatment, the brain ages 3 1/2 years. Remember B-E F-A-S-T, the stroke acronym, which stands for Balance, Eyes, Face, Arms, Speech and Time — as in, time to call 9-1-1. 21—It was just after 2 p.m. on Monday, Sept.

First Responder 52

First Responder Mobile Integrated Health E-9-1-1 Community Paramedicine 52

Don't Forget the Bubbles

DECEMBER 16, 2024

Coverage of the 6-in-1 vaccine measured at 12 months of age in England for Q4 2023 to 2024 Source: ONS under the Open Government License v3.0 Young infants and immunosuppressed individuals are particularly at risk of severe disease, resulting in significant morbidity and associated mortality rates of 1-3 per 1,000 cases.

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E-9-1-1 OR ALS Emergency Department 57

EMDocs

MAY 19, 2025

Medications (most common cause): allopurinol, anticonvulsants (phenytoin, phenobarbital, carbamazepine, lamotrigine), antimicrobials (Sulfa meds, quinolones, PCN, HIV meds), steroids, NSAIDs, immunizations (Table 1). Acute: lasts 7-9 days. 1 mL/kg/hr. 2021;57(9):895. 2010;88(1):60-68. 2010;31(1):100-4.

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E-9-1-1 ALS ED Critical Care 78

JEMS

JULY 2, 2025

In any event, the doctor on call arrived, promptly undid all our doing, and told the patient to “Get off that damn board and walk around. References 1. Berg G, Nyberg S, Harrison P, Baumchen J, Gurss E, Hennes E. Barnhard By Roy Danks, DO It’s time to decommission the long spine board. One room, two beds.

Mobile Integrated Health 98

Mobile Integrated Health E-9-1-1 EMT EMT 98

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. 2010 , 87 , 1348. Food and Drug Administration.

Mobile Integrated Health 98

Mobile Integrated Health EMS E-9-1-1 Community Paramedicine 98

EMDocs

JULY 21, 2025

SCAPE defining features: 1) rapid onset of respiratory distress (<4-6 hours); 2) pulmonary edema with severe dyspnea; 3) abdominal vital signs with SBP > 160 and/or > 120, hypoxic, tachypneic, tachycardic; 4) critically ill, evidence of pulmonary edema. Evaluate for ≥ 3 B lines in two bilateral lung zones. What about diuretics?

E-9-1-1 88

E-9-1-1 ALS Emergency Department OR 88

JEMS

JULY 9, 2025

1 Obviously, this is an extreme case; however, it illustrates that field amputations can be successful even in the most primitive conditions. The Gigli saw technique had an instrument malfunction on 3/9 trials which was distinct from the other techniques. 1996 Jan-Mar;11(1):63-6. sec (mean ± SD), hacksaw technique 6.28 ± 0.76

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E-9-1-1 EMT EMT Mobile Integrated Health 102

Pediatric EM Morsels

MARCH 7, 2025

Shakur H, Roberts I, Bautista R, Caballero J, Coats T, Dewan Y, El-Sayed H,Gogichaishvili T, Gupta S, Herrera J, Hunt B, Iribhogbe P, Izurieta M, Khamis H, Komolafe E, Marrero MA,Meja-Mantilla J, Miranda J, Morales C, Olaomi O, Olldashi F, Perel P, Peto R, Ramana PV, Ravi RR,Yutthakasemsunt S. 2012 Feb;147(2):113-9. 2020;2(1):e0075.

E-9-1-1 231

E-9-1-1 ALS OR ED 231

REBEL EM

MAY 19, 2025

Margin: Allowed up to 1 in 25 more deathsthough stricter than past trials. of patients in the 7-day group received antibiotics for longer than 9 days, while 5.8% REBEL Rundown Key Points Generalizability: Mostly Canadian patients with gram-negative UTIs or abdominal infections. Gram-Positive? male Setting at enrollment: ICU: 55.0%

E-9-1-1 54

E-9-1-1 ICU ALS OR 54

REBEL EM

JULY 14, 2025

📊 Noninferior Outcomes: At 3 months, functional outcomes (QDASH) were noninferior with bandaging; ROM was better at 2 weeks, and no difference in serious events or nonunion was observed. About 1 in 10 patients will have an occult fracture, and roughly 1 in 10 scaphoid fractures result in nonunion. 2025;26(1):14.

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E-9-1-1 ALS OR ED 103

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. It can also serve as a clinical decision tool in the rare event of choosing between two equally well-thought-out plans. Gorchynski J, Karabidian E, Sanchez M. J Emerg Med.

Emergency Department 52

Emergency Department E-9-1-1 ALS OR 52

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 78

EMS E-9-1-1 Overdose ALS 78

Don't Forget the Bubbles

JULY 1, 2025

Most of you will recall the JC list of February 2025, where a large Swedish study showed no association with neuropsychiatric adverse events of montelukast in children. Best wishes, Anke and Jaan 1.Reviews Feasibility and Acceptability of Recommending HPV Vaccine at Ages 9-10 Years. 2025 Jun 9. 2025 Jun 9:e2024070309.

E-9-1-1 93

E-9-1-1 ALS OR STEMI 93

Don't Forget the Bubbles

APRIL 7, 2025

This small but mighty gland, roughly 1 cm in diameter, sits at the base of the brain, just below the hypothalamus. The likelihood of a pituitary adenoma increases with age, accounting for 1% of all intracranial tumours before 15 years but rising to 18% in adolescents aged 1524. The most commonly used stimulation tests include: 1.

E-9-1-1 70

E-9-1-1 Plasma ALS OR 70

EMDocs

MARCH 18, 2025

Episode 116: Massive Hemoptysis Definition: Hemoptysis is expectoration of blood from the respiratory tract; ranges from mild with small streaks of blood to cardiopulmonary compromise (1-5). Massive hemoptysis: no clear definition, ranges from 50 mL in a single expectoration to 100 mL in 24 hours to over 1 L in 48 hours.

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E-9-1-1 FFP ALS Critical Care 70

ACEP Now

MARCH 10, 2025

1 If you enter the Isegahama stable today, you might find Satonofuji diligently training, but you will also find him performing lower-ranked sumo duties such as simmering chanko nabe or sumo stew for others, sweeping the communal living areas, cleaning the bathrooms, or carrying the higher ranked sekitori sumos belongings during tournament days.

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E-9-1-1 ALS OR CPR 85

EMDocs

FEBRUARY 22, 2025

Answer : CSF Leak Epidemiology: CSF leaks are broken into three main causes Craniofacial trauma: approximately 80% of cases 1 3% of blunt head and 9% of penetrating head trauma patients have CSF leaks Basilar skull fractures commonly occur with CSF leaks (up to 30%) Iatrogenic: approximately 16% of cases 1 3.8% Epub 2021 Sep 9.

E-9-1-1 63

E-9-1-1 EMS Plasma OR 63

EMDocs

JUNE 14, 2025

CT head/CTA head and neck are unremarkable, but MRI brain reveals that this 23-year-old otherwise healthy female has had a stroke. Question: What is the diagnosis?

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E-9-1-1 EMS ALS ED 99

EMDocs

MAY 31, 2025

Physical exam: Appears thin with dry mucous membranes Abdomen is soft, nondistended, and mildly tender diffusely Ulcers present on the uvula and soft palate Labs: WBC 21 10 9 /L, HGB 7.1 2002;15(1):79-94. 2019;2019:1-16. g/dL, MCV 67 fl, PLT 849,000/uL, ESR 39 mm/hour, CRP 6.4 mg/L, Na 132 mEq/L, K 2.7 mEq/L, Cr 0.5

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E-9-1-1 EMS ALS Emergency Department 74

Pediatric EM Morsels

JULY 19, 2024

Since tonsillectomy is one of the most common pediatric surgeries in the US (~500,000 per year) and the rate of post-tonsillectomy hemorrhage is about 1-5% , it is a good idea that we all are familiar with how to manage this issue! 2020 Sep;38(9):1943. Rohe E, Gresham M, Rohde R, Cass L, Brinkmeier JV, Childers A. 2020.01.042.

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

Pediatric EM Morsels

SEPTEMBER 22, 2023

Pathophysiology Primary injury happens at the time of the traumatic event or shortly after in the high cervical to mid-thoracic spine. Negative E-FAST and no signs of long bone injuries should raise concern for neurogenic shock in the hypotensive trauma patient with suspected spinal injury. 2011;46(9):1771. J Pediatr Surg.

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E-9-1-1 Epinephrine ALS ED 307

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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E-9-1-1 Coronary ACS BLS 134

Pediatric EM Morsels

NOVEMBER 17, 2023

Cuffed Endotracheal Tubes show no difference in immediate post-extubation adverse events (i.e Bibl K, Pracher L, Küng E, Wagner M, Roesner I, Berger A, Hermon M, Werther T. 1994 Jul;125(1):57-62. 2019 Sep;74(9):1186-1190. 2016 Feb;30(1):3-11. Risk was Overstated! You have options, but one is more right!!

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E-9-1-1 Operating Room Emergency Department ALS 190

Dr. Smith's ECG Blog

OCTOBER 3, 2024

I agree, however: 1) I don't think you can get a good enough ech o without bubble contrast. 3) E cho is another step that takes time. I had only 9 false positives but I missed 2 OMI. The rhythm for the ECG in Figure-1 is sinus — with normal intervals and axis ( mean QRS axis about +80 degrees ). Time is myocardium.

E-9-1-1 130

E-9-1-1 Coronary ALS ED 130

ALiEM

AUGUST 16, 2023

Common agents include local anesthetics, dapsone, quinones, sulfonamides, phenazopyridine, and nitrites [1, 2]. Treatment for methemoglobinemia in G6PD deficiency may consist of ascorbic acid, exchange transfusion, and hyperbaric oxygen [7, 9]. PMID 23953868 Mack E. Rosen PJ, Johnson C, McGehee WG, Beutler E. 164.11.1192.

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E-9-1-1 ALS OR 130

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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E-9-1-1 OR ALS 116

Dr. Smith's ECG Blog

NOVEMBER 14, 2023

Learning Point: 1. link] = My Comment by K EN G RAUER, MD ( 11/14 /2023 ): = One of the most helpful clinical clues in support that an acute cardiac event is ongoing — is the finding of " dynamic " ECG changes. Figure-1: Comparison between the first 3 ECGs in today's case. How Would YOU Interpret the Serial Tracings in Figure-1?

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E-9-1-1 Coronary ED EMS 122

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. Musculoskeletal Adverse Events include: Articular cartilage damage causing arthralgias or arthritis , Tendonitis , and Tendon rupture. Which is a risk of 1 event for 62.5

E-9-1-1 130

E-9-1-1 ACS OR ALS 130

Don't Forget the Bubbles

AUGUST 30, 2023

The parents of 9-month-old Josie bring her into the Emergency Department with coryzal symptoms and difficulty breathing. Among those who do not always obtain a CXR, one-fifth still routinely obtained them under a certain age (2 weeks to 12 years, median of 1 year). doi: 10.1590/s1516-31802007000300005 Beyyumi, E., AlDhanhani, H.,

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E-9-1-1 Emergency Department ALS OR 130

EMDocs

MARCH 2, 2024

Answer : Pneumocephalus 1-21 Background: Pneumocephalus is defined by the presence of air within the cranial cavity. 1-3] The most common location is the frontal region, followed by the occipital and temporal regions. [4] 1-3] The most common location is the frontal region, followed by the occipital and temporal regions. [4]

EMS 109

EMS E-9-1-1 OR ED 109

Don't Forget the Bubbles

NOVEMBER 22, 2023

Of these signs, mortality in children is associated with hepatomegaly and fever; meanwhile, mortality in adults is associated with hyperkalaemia, traumatic brain injury, propofol infusion rates >5mg kg -1 h -1 and ECG changes. 1998;8(6):491-9. Vanlander AV, Okun JG, de Jaeger A, Smet J, De Latter E, De Paepe B, et al.

E-9-1-1 125

E-9-1-1 Critical Care Operating Room ALS 125

REBEL EM

MAY 27, 2024

No significant differences in heart rate 1 minute after cardioversion were observed between the three groups. There are no significant adverse events from the combination therapy.” Our Conclusion: This study presents a novel topic but is riddled with methodological flaws. 2010;17(1):44-49. seconds (range: 22.5,

OR 130

OR E-9-1-1 ED ALS 130