Dr. Smith's ECG Blog

DECEMBER 19, 2023

Two thirds of MINOCA cases are due to atherosclerotic causes One way to prove the diagnosis in this case would have been with intravascular imaging such as optical coherence tomography (OCT) or intravascular ultrasound (IVUS). Fortunately, that is exactly what happened. The patient did well afterward without any recurrence of symptoms.

EKG/ECG 127

EKG/ECG EMS Wellness Operations 127

Pediatric Emergency Playbook

MARCH 1, 2016

Often children even with high-grade splenic and liver lacerations can be managed non-operatively. Unfortunately, a negative FAST cannot help with detecting or grading the laceration for non-operative management. CT Abdomen and Pelvis, IV contrast: helpful in grading splenic and liver lacerations with goal to manage non-operatively.

Resuscitation 40

Resuscitation Pediatrics Hyperthermia / Hypothermia Operations 40

Taming the SRU

AUGUST 30, 2023

Similarly, a 2013 meta-analysis of 6 studies with 1,006 patients published in the American Journal of Emergency Medicine showed neither CRP nor PCT are sufficient to rule-in or rule-out infective endocarditis, with PCT having a pooled sensitivity of 64% and specificity of 73% and CRP having a pooled sensitivity of 75% and specificity of 73% [40].

Infectious Diseases 89

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

Advanced Emergency Nursing from AENJ

FEBRUARY 29, 2016

Farrington] Rebuilding of outdated hospitals put emergency rooms on ground level with nearby X-ray service, and, ideally, sometimes closer to the Blood Bank and the Operating Rooms. Advances in Medical Imaging (CT, MRI, and Ultrasound) facilitating rapid, accurate, diagnosis affording new potential to save additional lives. 10/20/2013.

Emergency Nursing 40

Emergency Nursing EMS Resuscitation Military 40

EB Medicine

JULY 8, 2019

Jeff: Do note, however that 2013 guidelines do not recommend one procedure over another and leave that decision up to local surgical expertise, patient specific risk factors, and treatment goals. Jeff: Even more shockingly, some series showed a 52% repeat operation rate. These patients often require emergent operative intervention.

Emergency Department 40

Emergency Department Sepsis Operations Dehydration 40

Taming the SRU

FEBRUARY 19, 2024

12) Axillary While axillary arterial line placement has been uncommon, in the age of facile ultrasound operators it may become a more advantageous and accessible site particularly in patients with high BMIs. Shock 40(6):p 527-531, December 2013. | Placement is theoretically faster and easier than a radial arterial line.

Shock 59

Shock Resuscitation Ultrasounds Research 59

Pediatric Emergency Playbook

JUNE 1, 2017

Fontan Operation and the Single Ventricle. 2013; 34(3):489-491. Cardiovasculr Ultrasound. 2013; 34(4). 2013; 8(2):61-63. 2013; 6(5):752-761. References Congenital AboulHosn JA et al. Congenit Heart Dis. 2007; 2:2-11. Aliku TO et al. World Journal for Pediatric Congenital Heart Surgery. 2014; 5(4)L631-634.

Pediatrics 52

Pediatrics EKG/ECG Wellness Seizures 52

Rural Doctors Net

AUGUST 30, 2013

Smart retrieval services have a presence in the Emergency Operations Centre and will be ‘on standby’ as the initial ambulance call comes through – a much more proactive approach than the usual sequence of calls from first responder-ambulance-local hospital-doctor-retrieval service. How to intubate? Emlyns on the PROMMT data.

Burns 52

Burns Hospitals Ambulance Services Wellness 52

Don't Forget the Bubbles

FEBRUARY 7, 2024

One systematic review of 1283 patients showed that if you got to the operating room within 6 hours, you had a 97% chance of saving the testicle. Urgent senior review, decision making and operation 31.3% What is the role of ultrasound? This dropped to 79.3% of patients were first seen by a junior specialist trainee.

Pediatrics 111

Pediatrics Ultrasounds Operations Hospitals 111

EMDocs

OCTOBER 23, 2023

Operative complications requiring surgical intervention or hospitalization occur in about 3-6% of all hysterectomies (5). difficile infection, and post-operative hemorrhage. Abscess and Infected Hematoma : This condition is typically delayed, occurring most commonly 10-14 days post-operatively.

OB/GYN 93

OB/GYN Operations EMS Ultrasounds 93

EMDocs

JUNE 21, 2023

A 2013 study found a sensitivity of ~47% for TA of the knee using plain radiographs. Common operator errors Failing to enter joint capsule before injecting STS. 2013 Sep;27(9):509-14. Can Ultrasound Identify Traumatic Knee Arthrotomy in a Cadaveric Model? While suggestive of TA, not sensitive or specific. PMID: 23412508.

Soft Tissue Injuries 95

Soft Tissue Injuries Fractures Dislocations Radiology 95

Pediatric Emergency Playbook

JANUARY 1, 2017

Neonatal observational scales have been validated in the intensive care and post-operative settings; ED-specific quantitative scales are lacking. CRIES ( Table 1 ) was validated for post-operative patients; to adapt its use for the ED, the most conservative approach is to substitute “preoperative baseline” with normal range for age.

Pediatrics 40

Pediatrics Soft Tissue Injuries Burns Emergency Department 40

ACEP Now

APRIL 4, 2024

The diagnosis is confirmed with bedside ultrasound (US) or CT. Other exceptions are patient refusal, patient death or immediate transfer to the operating room. Ultrasound of the aorta is a core competency of emergency physicians, but resources such as Sonoguide are available for a refresher at acep.org/sonoguide. J Vasc Surg.

Operations 40

Operations Ultrasounds Emergency Department 40

EB Medicine

JANUARY 2, 2019

Jeff: Perhaps most importantly, no history or physical alone can rule in or out an ectopic pregnancy, for that you’ll need testing and imaging or operative findings. So to get us all on the same page, the discriminatory zone is the b-HCG at which an IUP is expected to be seen on ultrasound. Jeff: Up first is the urine pregnancy test.

Ultrasounds 40

Ultrasounds Radiology Radiology Infectious Diseases 40

EMDocs

NOVEMBER 13, 2023

26 With regards to penetrating neck injuries, particularly those in which the platysma is violated, CTA of the neck has allowed a shift away from mandatory operative exploration of Zone 2 neck wounds (those in the mid-neck). Semin Ultrasound CT MR 2017, 38 (4), 345-356. Am Surg 2013, 79 (1), 23-29. 32 Table 2 : Memphis Criteria.

Stroke 105

Stroke Radiology Radiology Emergency Department 105

Don't Forget the Bubbles

SEPTEMBER 23, 2024

suprapubic catheters, gastrostomy tubes, haemodialysis or peritoneal dialysis lines – may have been left in situ in the initial post-operative period), and central vascular catheters. Look for scars indicating previous central lines, peritoneal dialysis catheters or operations. If in doubt, ask. CAKUT, catheterization requirement).

Pediatrics 52

Pediatrics Fractures Dehydration Sepsis 52