Dr. Smith's ECG Blog

JUNE 8, 2023

OMI Manifesto About Resources Teaching Images Lectures + Podcasts Rules + Equations OMI Literature Timeline OMI Facts and References The OMI Quizzes OMI Pocket Guide Cardiac CATH Guide QTc Calculator Lead Reversals-Artifact Neuroprotective CPR OMI AI: The Queen of Hearts Thursday, June 8, 2023 Fever 104.9, hypoxia, altered mental status, hypotension, MSSA bacteremia 2421022 Fever 104.9, hypoxia, altered mental status, hypotension, MSSA bacteremia massive PE intervention Posted by Steve Smith at

STEMI 52

STEMI Coronary CPR ACS 52

Emergency Medicine Cases

JUNE 6, 2023

In this ECG Cases blog we look at 10 patients with shortness of breath, and discuss how the ECG can be used to help diagnose cardiac, respiratory and metabolic emergencies. We discover that for STEMI/OMI vs subendocardial ischemia, we should look for STEMI(-)OMI, subacute OMI, and OMI in the presence of LBBB and RBBB, and consider the differential for diffuse ST depression with reciprocal ST elevation in aVR.

STEMI 288

STEMI EMS 288

ALiEM

JUNE 15, 2023

Which cardiotoxic plant is shown? Lily of the valley Moonflower Morning glory Water hemlock White snakeroot Reveal the Answer 1. Lily of the Valley What type of plant is lily of the valley? Lily of the valley ( Convallaria majalis ) is a woodland perennial with a sweet scented, white bell-shaped flower. It blooms from April to June in North America and bears orange-red berries in July [1].

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ALS ED OR 246

Pediatric EM Morsels

JUNE 2, 2023

Rare diseases are not confined to the pages of a textbook or computer screen. Our patients have varied past medical histories that require us to be well-versed in even the most uncommon disorders (or know where to look things up in a pinch)! Today we are talking about a rare disease called FPIES (food protein induced enterocolitis syndrome) and how you might encounter these patients in the Pediatric Emergency Department.

Emergency Department 196

Emergency Department ALS EMS OR 196

The Skeptics' Guide to EM

JUNE 17, 2023

Date: June 15, 2023 Reference: Rees CA et al. Intranasal fentanyl and discharge from the emergency department among children with sickle cell disease and vaso-occlusive pain: A multicenter pediatric emergency medicine perspective. American Journal of Hematology Jan 2023 Guest Skeptic: Dr. Amy Drendel is a pediatric emergency medicine physician and physician scientist at Children’s Wisconsin. […] The post SGEM#406: Homeward Bound…after a dose of Intranasal Fentanyl for Sickle Cell Vaso-occlusive

Emergency Department 185

Emergency Department ALS ED OR 185

The Bottom Line

JUNE 19, 2023

In adult patients with major trauma, who are at risk for trauma-induced coagulopathy does early administration of 1g of tranexamic acid (TXA) followed by an infusion of 1g over 8 hours, compared with placebo, increase survival with a favourable functional outcome at 6 months?

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Don't Forget the Bubbles

JUNE 19, 2023

You are asked to see a baby boy in the labour ward. He was born at 38 weeks and 5 days gestational age and weighs 2600 grams. His mother is healthy, but she does mention that her first-born daughter was also small. She weighed 2570 grams at 39 weeks and is now perfectly healthy. The parents are of South-Asian descent. There were no issues during the pregnancy, and estimated fetal growth by ultrasound was constant.

ALS 143

ALS OR 143

ALiEM

JUNE 1, 2023

Are you using phenobarbital instead of benzodiazepines as the first-line monotherapy for patients in alcohol withdrawal in the Emergency Department (ED)? If not, you probably should be. Another old drug for a new indication, right? Well not exactly. Phenobarbital is indeed an older and relatively cheap drug (less than $20 per loading dose) that has gained some press recently for the treatment of acute alcohol withdrawal [1-3].

ICU 246

ICU Emergency Department ED OR 246

Pediatric EM Morsels

JUNE 16, 2023

The subcutaneous space is a vast region of potential space where things can collect. Sometimes this can be used to our advantage, like when we need to give subcutaneous fluids to a dehydrated patient without an IV, or when we need to give SQ medications for things like Sulfonylurea overdose , Hereditary Angioedema , or DVTs. Sometimes, however, these deeper layers of the subcutaneous space can collect dangerous infections , like Necrotizing Fasciitis.

Overdose 157

Overdose OR ALS Critical Care 157

REBEL EM

JUNE 14, 2023

Anaphylactic Shock is an acute, life-threatening hypersensitivity disorder, with a generalized, rapidly evolving, multi-systemic allergic reaction (IgE-mediated disorder). If not treated rapidly can become fatal. Scott Weingart, MD put together a manual titled the Resuscitation Crisis Manual , which in short, is composed of two-page protocols for various situations that involve crashing patients.

Allergic Reaction 143

Allergic Reaction Epinephrine OR EMS 143

EMCrit Project

JUNE 1, 2023

Optimization of Emergency Medicine Teams EMCrit Project by Scott Weingart, MD FCCM.

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First 10 EM

JUNE 19, 2023

The internet is alive with rumors of a simple, cheap, low-risk cure for long COVID. Sound too good to be true? That’s because it almost certainly is. Let’s talk about this COVIT-OUT trial and what it says about metformin. The paper Bramante CT, Buse JB, Liebovitz DM, et al. Outpatient treatment of COVID-19 and incidence […] The post No, metformin is probably not the cure for long COVID appeared first on First10EM.

ALS 141

ALS EMS 141

Emergency Medicine Cases

JUNE 27, 2023

We miss potentially dangerous and even lethal drug interactions in EM more often than we realize. In this main episode EM Cases podcast with Dr. David Juurlink and Dr. Walter Himmel we review the common categories of drugs, the high risk patients and the key drug interactions that we need to know about in Emergency Medicine. The post Ep 184 Must Know Drug Interactions in Emergency Medicine appeared first on Emergency Medicine Cases.

EMS 235

EMS 235

EMergucate

JUNE 27, 2023

The following chest x-ray is from an adolescent with chest pain, fever and dyspnoea. What can be seen?

EMS 130

EMS 130

Pediatric EM Morsels

JUNE 9, 2023

When we think of severe hemorrhage in children, we typically think about trauma. Maybe injuries to the spleen or kidney come to mind. Perhaps thoughts of pelvic injuries or severe head injury dominate our considerations. Of course, we all have a healthy respect for post-tonsillectomy hemorrhage and we like to talk about Damage Control Resuscitation.

OR 157

OR EMS Critical Care 157

Core Ultrasound

JUNE 14, 2023

I’m so proud to be living my truth and sharing my story with you all! Join me in this special episode where I share just a little bit of my journey of coming out to the rest of the world as a transgender woman. Also, there are 5 other reasons to watch: I’ll share with you my favorite ultrasound cases of the past few months. I hope you enjoy this wide-ranging talk on some pretty important and amazing topics!

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High Performance EMS

JUNE 12, 2023

During the height of the COVID pandemic, shortages led to many operational challenges that required creative solutions. One of the more challenging issues that has become as endemic as the disease itself is the recruitment and retention of EMS professionals. This shortage has disproportionally impacted paramedics, as evidenced in the NAEMT survey results published in May of 2022.

BLS 130

BLS UHU Paramedic ALS 130

First 10 EM

JUNE 12, 2023

Can herbs cure sepsis? The EXIT-SEP trial was just published, and demonstrated a decrease in all cause mortality from xuebijing – a product manufactured by a pharmaceutical company from a combination of Carthamus tinctorius flowers (Honghua in Chinese), Paeonia lactiflora roots (Chishao), Ligusticum chuanxiong rhizomes (Chuanxiong), Angelica sinensis roots (Danggui), and Salvia miltiorrhiza roots (Danshen). […] The post Finally, a cure fore sepsis: Herbs appeared first on First10EM.

EMS 136

EMS 136

Emergency Medicine Cases

JUNE 26, 2023

With increasing forest fires, heat waves, floods, storms, vector-borne illnesses and heat waves, the emergency department is uniquely positioned to declare sentinel events, advocate on behalf of vulnerable populations and lead by example. Dr. Matt Douglas-Vail explains the need for Increased education on climate change and planetary health, Increased resource allocation in emergency departments for climate-related pathologies and increased disaster planning for climate-related emergencies on thi

EMS 210

EMS Emergency Department 210

EMergucate

JUNE 26, 2023

Boot shaped heart The frontal chest x-ray shows boot-shaped heart and pulmonary plethora.

EMS 130

EMS 130

Don't Forget the Bubbles

JUNE 26, 2023

In this case-based article, we’ll talk about single ventricle defects and their management (both medical and surgical), then look at the two main shunt options during Stage 1 reconstruction. Single ventricle defects Many complex congenital heart defects have single ventricle physiology. This means that one ventricle is too small, weak or obstructed to pump effectively, leaving the other ventricle to supply both systemic and pulmonary circulations in parallel via a shunt such as the ductus

Critical Care 127

Critical Care ALS OR CPR 127

Medgadget

JUNE 6, 2023

Researchers at the University of California San Diego have created a wearable ultrasound system that can monitor deep tissues, as far as 16.5 cm (6.5 inches) below the surface of the body. Moreover, the team employed a machine learning algorithm to reduce the noise associated with movement, helping to obtain reliable readings while the wearer goes about their day.

OR 125

OR 125

ACEP Now

JUNE 21, 2023

U.S. emergency medicine (EM) residency training length has been a decades-long dilemma: four vs. three years. Two important questions befall educators and residents. First, is three years enough time to become an EM physician? Second, does an additional year add sufficient value to justify the time and expense? To date, the debate has been lively yet largely conceptual.

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EMS ALS Emergency Medical Services OR 114

First 10 EM

JUNE 26, 2023

I think the conclusions of the paper are incredibly obvious, and therefore not practice changing, but I worry that a superficial read might lead to misinterpretation, and therefore the paper is probably worth covering. (This is the same research group that published the infamous PESIT study, and all the subsequent misinformation about PE risk in […] The post PE risk in severe exertional dyspnea appeared first on First10EM.

EMS 130

EMS 130

Critical Care Scenarios

JUNE 28, 2023

The value of performing chart checks to see how your patients are doing after your care. The value of performing chart checks to see how your patients are doing after your care.

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EMergucate

JUNE 26, 2023

The chest x-ray shows features of right middle lobe pneumonia. There is air space opacity silhouetting the right heart border.

EMS 130

EMS 130

Chicago EMT Training

JUNE 20, 2023

We've recently uploaded a public study guide on our website. We've been toying with the idea of creating a database for mentors and we'd like to open it to anyone that would be interested! This role is strictly remote and unpaid. Students could be reaching out for advice, study tips, difficult topics, career advice Here's the application: Let us know if you have any questions or concerns!

EMT 100

EMT EMT OR 100

Medgadget

JUNE 9, 2023

Researchers at George Washington University have created a swallowable capsule containing a video camera that can assist in identifying lesions in the stomach. However, unlike similar devices that have been developed previously, this capsule can drive around the stomach under the control of a clinician. This allows it to thoroughly navigate and screen the entire area to identify any health issues in the stomach mucosa, such as ulcers or bleeding.

OR 110

OR 110

Dr. Smith's ECG Blog

JUNE 28, 2023

EMS was dispatched for a 30-something male who feels his heart is racing. Sudden onset. The patient had no previous medical history. Vitals were normal except for a heart rate of 226. A prehospital 12-lead was recorded: There is a regular wide complex tachycardia. The computer diagnosed this as Ventricular Tachycardia. Is it definitely VT?? The patient was given 6mg, then 12 mg, of adenosine, without a change in the rhythm.

OR 98

OR ED EMS 98

EMDocs

JUNE 22, 2023

Author: Taylor Webb, MD (Emergency Medicine Resident, University of Mississippi Medical Center) // Reviewed by: Brit Long, MD (@long_brit) I am a third year Emergency Medicine chief resident at the University of Mississippi Medical Center (UMMC) and want to share one of my experiences to all medical residents and providers. Remember that while mistakes in resuscitation are often dissected and analyzed, it is equally crucial to acknowledge and celebrate the moments of impeccable execution, where

ED 98

ED Paramedic OR EMS 98

Critical Care Scenarios

JUNE 21, 2023

Bryan puts Brandon through the paces, discussing the nuts and bolts of managing a code. Find us on Patreon here! Buy your merch here! Takeaway lessons Bryan puts Brandon through the paces, discussing the nuts and bolts of managing a code. Find us on Patreon here! Buy your merch here! Takeaway lessons * Managing a room is less about asserting authority and more about leading by example.

Coronary 100

Coronary 100

EMergucate

JUNE 26, 2023

The neck x-ray shows Diffuse subcutaneous emphysema in the neck.

EMS 130

EMS 130

The Bottom Line

JUNE 19, 2023

In patients resuscitated from out-of-hospital cardiac arrest (OOHCA) does targeted mild hypercapnia compared to targeted normocapnia improve 6-month neurological outcomes?

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Medgadget

JUNE 1, 2023

Researchers at Penn State have developed a low-cost, wearable sensor using pencil-on-paper technology. This approach involves depositing graphite (pencil ‘lead’) on paper that has been treated with sodium chloride, to create a conductive, low-cost sensor. Previously, these researchers had developed such sensors to detect moisture and even used them to develop a smart diaper ( yes, really ).

OR 103

OR 103

Dr. Smith's ECG Blog

JUNE 21, 2023

Sent by Magnus Nossen MD, written by Pendell Meyers A man in his 50s, previously healthy, developed acute chest pain. EMS was called, and they recorded the following ECG on scene at 13:16: What do you think? Below is the version standardized by PM Cardio app Meyers interpretation: Findings are specific for posterior (and also likely inferior) wall transmural acute infarction, most likely due to acute coronary occlusion (OMI).

STEMI 98

STEMI Defibrillator Coronary EMS 98

REBEL EM

JUNE 8, 2023

Background Information: Acute Hypotension is associated with increased morbidity and mortality. Continuous vasopressor infusions have previously been the mainstay of treatment. However, peripherally dosed push dose pressors, (PDPs), are beginning to be administered more frequently for management of acute hypotension. 1-4 The PDPs, phenylephrine and epinephrine, result in vasoconstriction and increased cardiac contractility.

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Epinephrine Emergency Department ALS ICU 98

Critical Care Scenarios

JUNE 14, 2023

The importance of using an app to keep notes and establish a second, more reliable medical memory. The importance of using an app to keep notes and establish a second, more reliable medical memory.

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