Dr. Smith's ECG Blog

JANUARY 20, 2024

Written by Pendell Meyers A man in his late 30s with history of hypertension, tobacco use, and obesity presented to the Emergency Department for acute chest pain which started approximately 3 hours prior to arrival, in the setting of a very stressful situation. de Winter et al in N Engl J Med 359:2071-2073, 2008.

EKG/ECG 121

EKG/ECG Documentation/Coding Emergency Department Hospitals 121

EMDocs

JULY 25, 2024

Do them well and document the process, preferably at the bedside. Literature-based Recommendations for Suicide Assessment in the Emergency Department: A Review. The post Medical Malpractice Insights: The challenge of suicide evaluation in the ED appeared first on emDOCs.net - Emergency Medicine Education. Applebaum PS.

Documentation/Coding 104

Documentation/Coding Hospitals Patient Safety Emergency Department 104

EB Medicine

JULY 8, 2019

This month, we are sticking in the abdomen for another round of evidence-based medicine, focusing on Emergency Department Management of Patients With Complications of Bariatric Surgery. Jeff: Well that’s kind worrisome. From the 80’s to 2008, the worldwide prevalence of obesity nearly doubled! million adults!!

Emergency Department 40

Emergency Department Sepsis Operations Dehydration 40

EMDocs

OCTOBER 30, 2023

Background and Context Contrast-enhanced computed tomography (CECT) is of paramount importance in the emergency department (ED) due to its indispensable role in facilitating precise diagnostic outcomes. Necessity-based system prioritizing CT contrast usage for emergent conditions (modified for ED-relevance). West J Emerg Med.

Radiology 99

Radiology Radiology Emergency Department Hospitals 99

ACEP Now

SEPTEMBER 5, 2024

Creation of an accurate database of emergency physicians living and working within a state, as well as a network of each states’ EM groups and ED medical directors would help chapter leaders disseminate relevant information, strengthen advocacy efforts, and plan regional solutions summits to focus on unique challenges.

Leadership 98

Leadership PPE EMS Wellness 98

EB Medicine

MAY 3, 2019

This month, we’re moving into uncharted territories for the podcast… we’re talking psychiatry Nachi: Specifically, we’ll be discussing Depressed and Suicidal Patients in the emergency department. The PSS-3 assesses for depression/hopelessness and suicidal ideations in the past 2 weeks as well as lifetime history of suicide attempt.

Emergency Department 40

Emergency Department Psychiatric Documentation/Coding Outcomes 40

EMDocs

APRIL 13, 2024

If the hematoma is not drained it can cause disruption of blood supply to the cartilage and subsequent necrosis, as well as an increase in risk of infection. A 21-year-old man presents to the emergency department for pain and swelling in his ear beginning 3 days ago. Prophylactic antibiotics are recommended. Roy S, Smith LP.

EMS 104

EMS Emergency Department Pediatrics Wellness 104

EMDocs

JANUARY 4, 2024

3 Bupropion blocks the reuptake of dopamine and norepinephrine, as well as antagonizes acetylcholine at nicotinic receptors. Case Follow-up: The patient required a dose of lorazepam in the emergency department. Ann Emerg Med. 2008 Apr;51(4):412-5, 415.e1. doi: 10.1016/j.annemergmed.2007.06.004. 2007.06.004.

Seizures 92

Seizures EKG/ECG Poisoning Shock 92

Dr. Smith's ECG Blog

APRIL 17, 2023

The remainder of his Emergency Department stay was uneventful. 4) There is well formed J-point notching. Here is the clinical informaton on ECG 2: A man in his 50s presented to the Emergency Department with acute chest pain that started within the past few hours. He had no symptoms of ACS.

EKG/ECG 52

EKG/ECG Documentation/Coding Emergency Department Psychiatric 52

Taming the SRU

MARCH 14, 2023

Case 1 Fussy 1 month old A 1-month-old (ex-34 week premature) infant comes to your emergency department for fussiness. He appears well and is triaged to an ESI 4. Case 2 19 year old seizure A 19-year-old male is brought into your emergency department via EMS for witnessed seizure-like activity.

Seizures 52

Seizures Emergency Department Pediatrics Critical Access 52

Taming the SRU

AUGUST 30, 2023

As the name would suggest, inflammatory markers are biological markers of, well, inflammation. While PCT may be more specific for bacterial infections, it is flawed by still being rather non-specific and is not validated as a stand-alone diagnostic criteria for infection in the setting of the emergency department. ng/mL, 0.25-0.5

Infectious Diseases 89

Infectious Diseases Sepsis Emergency Department Point-of-Care Testing 89

Dr. Smith's ECG Blog

DECEMBER 27, 2023

Written by Willy Frick A man in his 50s with a history of hypertension, dyslipidemia, type 2 diabetes mellitus, and prior inferior OMI status post DES to his proximal RCA 3 years prior presented to the emergency department at around 3 AM complaining of chest pain onset around 9 PM the evening prior. Elsevier/Saunders. Belhassen, B.,

EKG/ECG 131

EKG/ECG Documentation/Coding Wellness Emergency Department 131

EMDocs

APRIL 22, 2024

4 In an emergency department (ED) presentation of cardiac arrest, the diagnosis of PE is challenging without the use of CT angiography. Point-of-Care-Ultrasound (POCUS) is a bedside modality that can assist Emergency Physicians (EPs) in differentiating PE from other causes of cardiac arrest. 2008 Mar;28(3):370-2.

Ultrasounds 98

Ultrasounds Advances Cardiac Life Support (ACLS) EKG/ECG Resuscitation 98

EMDocs

JANUARY 29, 2024

Introduction: Neurologic emergencies are common in the Emergency Department (ED), and blood pressure management is critical to immediate management. 2008 Jul;26(7):1446-52. A non-contrast head computed tomography (CT) demonstrates a diffuse hyperdensity consistent with subarachnoid hemorrhage (SAH). 119.025514.

Stroke 99

Stroke Outcomes EMS Seizures 99

Northwestern EM Blog

JANUARY 10, 2022

For those well-appearing neurologically intact hyponatremia patients w/ sodium levels > 120, further work-up & analysis of the underlying etiology can be deferred to the inpatient side. Safety of Peripheral Line Administration of 3% Hypertonic Saline and Mannitol in the Emergency Department. J Emerg Med.

Administration 52

Administration Seizures Emergency Department Wellness 52

The Skeptics' Guide to EM

FEBRUARY 24, 2018

Case: 64-year-old male presents to your emergency department with worsening abdominal pain, nausea, vomiting and anorexia for the past week. Over the course of his emergency department stay he has escalating vasopressor requirements. He writes an excellent blog called EM Nerd , which he describes as nihilistic ramblings.

Shock 40

Shock Sepsis Emergency Department Resuscitation 40

ACEP Now

JANUARY 9, 2024

A 3-year-old male was brought to the emergency department (ED) by his mother, who reported the sudden onset of a rash (hives) covering his entire body, with no rash on his palms and soles. On physical examination, the child was non-toxic, well-nourished, alert, awake, and not in acute distress. No other complaints were noted.

Poisoning 52

Poisoning Pediatrics Emergency Department Wellness 52

Pediatric Emergency Playbook

AUGUST 1, 2017

One of our largest responsibilities in the Emergency Department is sorting out benign from surgical or medical causes of abdominal pain. Abdominal Surgical Emergencies in Children: A Relative Timeline General Advice Neonate (birth to one month) Necrotizing Enterocolitis Pneumatosis Intestinalis. J Med Genet 2008; 45:1.

Pediatrics 52

Pediatrics Ultrasounds Resuscitation Sepsis 52

ACEP Now

MAY 3, 2023

is a bit like emergency medicine, she says: “Every day is different with a different set of circumstances and range of problems to be solved.” When she took the role in 2008, it was a newly created job tasked with expanding AARP’s approach to making health products and services available to its members from third party companies.

EMS 52

EMS Outcomes Emergency Department Hospitals 52

Sensible Medicine

SEPTEMBER 29, 2023

The promise is that well-constructed and validated prediction models will lead to diseases being diagnosed earlier and treatment for the right patients, in the right place, at the right time. In some cases, models that appear to perform well may pose risks to patients if used to make clinical decisions. 2008 Feb;117(6):743-53.

Research 60

Research Hospitals Academics Emergency Department 60

Northwestern EM Blog

DECEMBER 20, 2021

Written by: Tommy Ng, MD (NUEM ‘24) Edited by: Patricia Bigach, MD (NUEM ‘22) Expert review by : Terese Whipple, MD '20 So your kid won’t walk One of the most common complaints in a pediatric Emergency Department is a child refusing or inability to ambulate. 2008 Jul;90(7):940-5. Affects ages 3-8, males to females 2:1 [3].

Pediatrics 52

Pediatrics Ultrasounds Emergency Department Radiology 52

Pediatric Emergency Playbook

DECEMBER 1, 2015

Victims of electrical injuries present either in extremis or as the seeming well patient with insidious, developing disease. Most patients do well, and the burn heals by secondary intention. Taser dispo: People who have been tased do remarkably well and complications are rare. Acad Emerg Med. 2008; 15:988-994.

Burns 40

Burns Emergency Department EKG/ECG Shock 40

Pediatric Emergency Playbook

SEPTEMBER 1, 2015

We can use intranasal drugs for analgesia, for anxiolysis, for seizures – but not all drugs used for those purposes will perform well – or at all – via the IN route. 2008 Oct;5(10):1159-68. Intranasal sufentanil provides adequate analgesia for emergency department patients with extremity injuries. Biol Neonate.

Administration 40

Administration Seizures Emergency Department Ultrasounds 40

ETM Course

MAY 3, 2017

Practical use of emergency tourniquets to stop bleeding in major limb trauma. 2008 Feb;64(2 Suppl):S38-49 Tourniquet use for civilian extremity trauma. Simple windlass-style tourniquets are relatively inexpensive, easy to apply and easy to operate. Ft Detrick, Maryland: Borden Institute; 2012. J Trauma Acute Care Surg.

Military 52

Military Shock Hospitals Operations 52

Don't Forget the Bubbles

MARCH 19, 2024

Becasue paediatric emergency departments are accessible out-of-hours they become the de facto place of safety with access to immediate support. Just 20% of a person’s health and general well-being is related to access to care and the quality of services. More ACEs can lead to increased rates of common childhood illnesses.

Hospitals 52

Hospitals Psychiatric Documentation/Coding Pediatrics 52

Sensible Medicine

SEPTEMBER 29, 2023

The promise is that well-constructed and validated prediction models will lead to diseases being diagnosed earlier and treatment for the right patients, in the right place, at the right time. In some cases, models that appear to perform well may pose risks to patients if used to make clinical decisions. 2008 Feb;117(6):743-53.

Research 40

Research Hospitals Academics Emergency Department 40

Dr. Smith's ECG Blog

OCTOBER 3, 2018

The medic was very worried about the concordant STE and T-wave in aVR, and the downsloping concordant ST depression in II, III, aVF, as well as V5 and V6. The Smith-Modified Sgarbossa Criteria Accurately Diagnose Acute Coronary Occlusion in Emergency Department Patients With Ventricular Paced Rhythm. What happened?"

EKG/ECG 52

EKG/ECG Emergency Department Research Outcomes 52

Advanced Emergency Nursing from AENJ

AUGUST 2, 2016

Act V, scene I [Text from Folger Shakespeare Library] [Audio recording of Dramatic Reading; Chapter Vox] [Video recording of Act V, scene1] Most deaths that are brought to, or occur in, an emergency department will require, at least, discussion with the local Coroner or Medical Examiner. Department of the Medical Examiner-Coroner.

Documentation/Coding 40

Documentation/Coding Forensics CDC Fractures 40

Don't Forget the Bubbles

JANUARY 27, 2025

We dont often cover gynaecological presentations in the emergency department and most chronic gynaecological problems go through the primary care referral pathway. However, CT scans remain largely more obtainable in a time critical case, in an emergency department setting. Pediatr Emerg Care, 1;38(6):e1332-e1335.

Ultrasounds 76

Ultrasounds Emergency Department Pediatrics Dehydration 76

EB Medicine

FEBRUARY 1, 2019

This month, we’re tackling an incredibly important topic - evaluation and management of life threatening headaches in the Emergency Department. Jeff: Interestingly, there may be a unique role for a d-dimer here as well. Seizures are very common as well. I’m Jeff Nusbaum, and I’m back with my co-host, Nachi Gupta.

Emergency Department 40

Emergency Department Stroke Outcomes Ultrasounds 40

RebelEM

MAY 15, 2024

The loss of these cells leads to immunosuppression as well as decreased responsiveness of the immune system as a whole Patients with neutropenia will not only get very sick very quickly, but also will have blunted immune response and may not localize signs of infection well Fever or malaise may be their only presenting symptoms.

Infectious Diseases 101

Infectious Diseases Administration Sepsis Anaphylaxis 101

EMDocs

JANUARY 20, 2024

Takotsubo syndrome is often exceedingly difficult to distinguish from acute myocardial infarction in the emergency department, as there is significant overlap in many clinical and diagnostic features. 2008 Mar;155(3):408-17. Vital signs show T of 99.0°F Troponin and B – type natriuretic peptide are often elevated.

EMS 101

EMS Fluid Resuscitation Shock EKG/ECG 101

ACEP Now

AUGUST 1, 2023

In November 2022, the American College of Emergency Physicians sent a letter to President Biden on behalf of 34 organizations, asking to convene stakeholders to identify solutions to address the emergency department (ED) boarding crisis.1 Acad Emerg Med. NQF re-endorsed the measure in 2014. NQF endorsement was removed.

Military 98

Military Hospitals Emergency Department Leadership 98

Pediatric Emergency Playbook

JANUARY 1, 2017

Tachycardia, tachypnea, and a change in behavior can be indicators not only to the presence of pain, but possibly to its etiology as well. For children greater than one year who are preverbal, a well performing scale is the FLACC score: Face, Legs, Activity, Cry, Consolability ( Table 3 ).

Pediatrics 40

Pediatrics Soft Tissue Injuries Burns Emergency Department 40

The Skeptics' Guide to EM

APRIL 3, 2021

Stroke 2021 Case: A 74-year-old man presents to the emergency department after waking up with left sided weakness. He was last seen well when going to bed at 10pm the night before. Those were ECASS-3 in 2008 and the NINDS trial from 1995. MRI-guided thrombolysis (0.6 THAWS RCT Substudy.

Stroke 52

Stroke Research Outcomes Emergency Department 52

Advanced Emergency Nursing from AENJ

MAY 27, 2015

An ambulance pulls up, in haste, to the Receiving door of the Emergency Department with a last squeal of the siren. Thereafter, “siege warfare” conditions prevail, and no one does very well with that, as in Mumbai, Waco , etc. September 2005) Terrorism and Other Public Health Emergencies Reference Guide for Media. [

Federal Emergency Management Agency 40

Federal Emergency Management Agency Military Hospitals Administration 40

Taming the SRU

JULY 21, 2023

Eye Pathology Now let’s dive back into some common eye disease processes you may see on a typical day in the emergency department. Patients will often have objective visual acuity impairment as well as a fever or leukocytosis. licensed under a Creative Commons Attribution 3.0 WHAT ARE TREATMENT OPTIONS? Accessed April 15, 2022.

Emergency Department 88

Emergency Department EMS Burns Wellness 88