Dr. Smith's ECG Blog

AUGUST 4, 2024

A DDENDUM ( 8/3/2024 ) : In the following 5 Figures — I post written summary from my ECG-2014-ePub on the ECG diagnosis of A cute P ericarditis. Bottom Line: Attention to details in the history relative to any of the above potential etiologies of pericarditis — is essential for making this diagnosis.

EKG/ECG 120

EKG/ECG Wellness Operations Emergency Department 120

Taming the SRU

OCTOBER 23, 2023

At this point, the patient is taken to the operating room for a diagnostic laparoscopy. She was taken to the operating room and found to have a right tubal ectopic pregnancy with a pseudogestational sac. 2007), Free Fluid in Morison's Pouch on Bedside Ultrasound Predicts Need for Operative Intervention in Suspected Ectopic Pregnancy.

Ultrasounds 98

Ultrasounds Operations Radiology Radiology 98

Taming the SRU

MAY 22, 2023

weight-bearing status, operative vs. non-operative) If necessary/helpful to ensure adequate follow-up At time of discharge: Counsel on expected course of injury, supportive care (e.g., 2014 May;4(3):432-5. A comparison between pre-operative ultrasonography and surgical findings. RICE), and symptomatic management (e.g.,

Fractures 77

Fractures Dislocations Operations Radiology 77

RebelEM

JANUARY 25, 2024

Point-of-care ultrasound (PoCUS) is inherently operator-dependent, which may have led to inconsistencies in the quality and findings of the ultrasound exams across different operators. 2014 Aug;2(8):638-46. Epub 2014 Jul 3. Lancet Respir Med. PMID: 24998674. Kok B, Wolthuis D, Bosch F, van der Hoeven H, Blans M.

Ultrasounds 125

Ultrasounds Outcomes COPD Hospitals 125

EMDocs

DECEMBER 2, 2023

2014 May;7(2):103-4. He has no known medical history and has never been to the doctor. Rosh Review Website Link FOAM Reading [link] [link] [link] References: Diyora B, Kukreja S, Nayak N, Kamble H, Sharma A. Complete third nerve palsy: Only presenting sign of extradural hematoma in an awake patient. Oman J Ophthalmol. doi: 10.4103/0974-620X.137177.

EMS 82

EMS Operations Pediatrics Emergency Department 82

Ken Grauer, MD

APRIL 23, 2023

IF dual AV nodal pathways were operative in today's case — then the BLUE arrow P waves in Figure-10 may be conducting with a very long PR interval — and — it may be that the WHITE arrow P waves are the ones that are not conducted because of this unusual pattern of Mobitz I.

EKG/ECG 195

EKG/ECG Wellness Operations Hospitals 195

EMDocs

MARCH 25, 2024

o Difficulty obtaining biliary views due to patient body habitus or pain o Operator dependent o Consultants requesting radiology performed ultrasound How to Perform a Biliary Ultrasound The preferred ultrasound probe for biliary ultrasound is the curvilinear probe due to its wider field of view and lower frequency. Acad Emerg Med.

Ultrasounds 97

Ultrasounds Radiology Radiology Operations 97

Taming the SRU

MAY 23, 2023

weight-bearing status, operative vs. non-operative) If necessary/helpful to ensure adequate follow-up At time of discharge Counsel on expected course of injury, supportive care (e.g., 2014 May;4(3):432-5. 2014 May;4(3):432-5. RICE), and symptomatic management (e.g., Ann Med Health Sci Res. doi: 10.4103/2141-9248.133473.

Fractures 57

Fractures Dislocations Operations EMS 57

RebelEM

JANUARY 25, 2023

Late findings Fever Abdominal distension (+) LR: 5.64 – 16.8 (-) LR: 0.34 – 0.43 Absent bowel sounds Peritoneal signs (i.e. rebound and guarding) Diagnostics Laboratory Tests Commonly ordered lab tests (i.e. 2.3 – 5.4) (-) LR: 0.18 (0.09 – 0.35) Ultrasound Findings Dilated loops of bowel (diameter > 2.5

Operations 52

Operations Sepsis Resuscitation Ultrasounds 52

RebelEM

MARCH 9, 2023

Prerost 2014) In a patient with chronic alcohol use, hallucinations should prompt consideration of acute intoxication, alcoholic hallucinosis, or delirium tremens (DT). Hamilton 2014) Patients with alcohol intoxication have an extremely high risk of intracranial pathology, and the threshold for obtaining head imaging should be very low.

Psychiatric 52

Psychiatric Emergency Department Fractures Documentation/Coding 52

Advanced Emergency Nursing from AENJ

MAY 3, 2014

Review of the Wellcome Library movies on YouTube (1945) [ links below in references ] is instructive as to resuscitative methods of the 1930s and 1940s: Manual methods; gas bag or bellows operated by hand or machine; an anesthesia gas machine; or iron lung. Resuscitation set, Europe, 1801-1850 - Science Museum, London. Fell-O’Dwyer Apparatus.

Resuscitation 40

Resuscitation Military Operations Emergency Nursing 40

The Skeptics' Guide to EM

NOVEMBER 20, 2021

In 2014 the SGEM looked at a systematic review by Dr. Chris Carpenter , which concluded that there wasn’t a good tool to help us predict which ED patients are at risk of recurrent falls ( SGEM #89 ). Background: We looked at geriatric falls on an SGEM Xtra in 2015. There are three other GEAR 1.0 Reference: Hammouda et al.

Geriatric Emergencies 52

Geriatric Emergencies Elder Abuse Research Academics 52

RebelEM

NOVEMBER 30, 2022

2014, (Ch) 99: p 1326-1356. In patients with a high suspicion for torsion, emergent surgical consultation should not be delayed by diagnostic imaging as “time is testicle” Scrotal Ultrasound Standard imaging technique Diagnostic characteristics Sensitivity: 88 – 100% (+ Lr = 8.8 – 10) Specificity: 90% (+) LR = 8.8-10,

Ultrasounds 52

Ultrasounds Pediatrics Operations EMS 52

PulmCCM

OCTOBER 16, 2024

Animal studies have suggested that the body could be prepped or trained to better withstand ischemic-reperfusion injury, by inducing mild ischemia in another tissue bed before the operation. The mechanism is unclear. Patients received RIPC after induction of anesthesia and before the initial incision.

Outcomes 52

Outcomes Operations Research Hospitals 52

Advanced Emergency Nursing from AENJ

DECEMBER 18, 2014

Classic Advice to New Interns (Commentary upon 10 Commandments of EM) Ten Commandments of Emergency Medicine Luke & Cusack Cork Emergency Medicine 2014 The Derriford twelve commandments of emergency medicine: a model for good practice in a changing world, or a survival guide for new medical staff Smith, J. Higginson, I.,

Mass Casualty Incidents 40

Mass Casualty Incidents Burns Urgent Care Pediatrics 40

Advanced Emergency Nursing from AENJ

NOVEMBER 20, 2014

Spinal Cord (2014) 52, 504–510; doi:10.1038/sc.2014.56; 2014.56; published online 29 April 2014 Evolution of Care and Survival In Medical Triumph, Homicides Fall Despite Soaring Gun Violence By Gary Fields and Cameron McWhirter. Spinal Cord (2014) 52, 504–510; doi:10.1038/sc.2014.56; de Barros Filho, T. Cristante, A.

Military 40

Military Forensics Documentation/Coding Emergency Nursing 40

Advanced Medical Reviews

SEPTEMBER 15, 2017

A Manatt Health study funded by the Robert Wood Johnson Foundation found that the total number of such clinics grew 900 percent between 2006 and 2014 , to 1,800 nationwide. Responding to millennial influence on healthcare technology and operations.

Operations 56

Operations Research Wellness Hospitals 56

Northwestern EM Blog

MAY 16, 2022

Follow up CT should depend on the patient and ultrasound operator. Lastly the POCUS operators were ED physicians with training “recommended by ACEP.” This is a great summary of the landmark randomized trial published in NEJM in 2014 assessing CT vs two types of US for patients with suspected renal colic in the ED setting.

Ultrasounds 52

Ultrasounds Radiology Radiology Outcomes 52

Advanced Emergency Nursing from AENJ

SEPTEMBER 17, 2014

If it is a large public event, with foreseeable risks, and admission is charged of other value exchanged, then it may be wise to contract for needed services from licensed and insured providers: Venue operators, Security firm; event medical crews or EMS stand-by providers; to provide some shielding to your group as to liability.

Operations 40

Operations Emergency Nursing Hospitals Pediatrics 40

Don't Forget the Bubbles

MARCH 11, 2024

Craniosynostosis needs urgent referral and is usually corrected operatively before a child’s first birthday. Craniosynostosis can lead to raised intracranial pressure and failure to thrive. and can worsen and become harder to correct over time. This can lead to intracranial hypertension and neurodevelopmental delay. link] van Wijk, R.

Radiology 59

Radiology Radiology Pediatrics Documentation/Coding 59

Taming the SRU

MAY 27, 2024

This often is seen in trauma, cancer, post-operatively, and end-stage metabolic conditions with excessive colloid or protein leak. If the volume of fluid is anticipated to re-accumulate quickly, a drain should be placed. a) left image: normal pleural cavity, image accessed from 2313 The Lung Pleurea - Pleural cavity - Wikipedia ; under CC 3.0

Emergency Department 87

Emergency Department Ultrasounds Radiology Radiology 87

Greater Sydney Area HEMS

APRIL 26, 2023

Although remember, as is observed intra-operatively from tourniquet application, muscle can tolerate hours of hypoxia. Halliwill JR, Sieck DC, Romero SA, Buck TM, Ely MR (2014) Blood pressure regulation X: what happens when the muscle pump is lost? This occurs via inadequate muscle perfusion. ST mechanisms can occur before then.

Hyperthermia / Hypothermia 52

Hyperthermia / Hypothermia Shock Research Operations 52

Don't Forget the Bubbles

SEPTEMBER 23, 2023

The New South Wales Doctors Orchestra ‘Musicus Medicus’ – 2014 An orchestra is a complex system with many moving parts. There is leadership operating at many levels. These were the exact same reasons I later studied medicine. The oboe opened an important door for me to the world of the symphony orchestra. Think about the composer.

Leadership 136

Leadership Teamwork Hospitals Emergency Department 136

ALiEM

MAY 13, 2024

63M with an Erythematous Abdomen Limitations of POCUS As with all ultrasound applications, soft tissue POCUS is operator dependent. 2014 Feb;15(1):111-3. Di Coneybeare) For additional reading on ultrasounding necrotizing fasciitis, see these ALiEM articles: QI Series: Cellulitis vs Necrotizing Fasciitis Ultrasound For The Win! –

Ultrasounds 64

Ultrasounds Pediatrics Emergency Department Wellness 64

Advanced Emergency Nursing from AENJ

APRIL 8, 2014

Artificial Respiration by Mouth-to-Mask Method — A Study of the Respiratory Gas Exchange of Paralyzed Patients Ventilated by Operator's Expired Air. Vintage Rescue Mouth 2 Mouth Breathing Venti-Breather Emergency Kit 1960 Cross ebay.com; accessed 4/7/2014 **Photographs (3) of Venti-Breather® device. S., & Elder Jr, J. Sands Jr, R.

Resuscitation 40

Resuscitation Ambulance Services Research Military 40

Pediatric Emergency Playbook

FEBRUARY 1, 2016

REBOA If you have access to resuscitative endovascular balloon occlusion of the aorta or REBOA, this may be an option to temporize the child to get him to the relative control of the operating room. 2014 Apr;133(4):e1104-16. Withholding or termination of resuscitation in pediatric out-of-hospital traumatic cardiopulmonary arrest.

Resuscitation 40

Resuscitation Pediatrics Fractures Emergency Department 40

Pediatric Emergency Playbook

JUNE 1, 2017

Fontan Operation and the Single Ventricle. 2014; 14(1): 23-227. 2014; 5(4)L631-634. 2014; 12:15. Summary Acute MI is a challenging presentation in children: Easily missed: uncommon and atypical Varied etiology Respect vague symptoms with a non-reassuring H&P Try to detect it: CATH IT! Congenit Heart Dis. 2007; 2:2-11.

Pediatrics 52

Pediatrics EKG/ECG Wellness Seizures 52

Dr. Smith's ECG Blog

SEPTEMBER 9, 2020

However, on occasion — dual AV nodal pathways physiology may be operative ( Mani BC & Pavri BB: Dual AV Nodal Pathways Physiology — Indian Pacing Electrophysiol 14[1]:12-25, 2014 ). P.S.: I fully acknowledge that my proposed mechanism for the laddergram in Figure-5 is not the only possible theory.

EKG/ECG 52

EKG/ECG Blood Transfusions Operations Hospitals 52

Pediatric Education

NOVEMBER 12, 2023

Pierre-Robin Sequence) and post-operative congenital heart disease. 2014-3527 Davis NL, Shah N. Babies recommended to be tested are infants < 37 weeks gestation, with some hospital protocols including babies at risk for cardiorespiratory problems such as hypotonia (e.g. neuromuscular problems, Down syndrome), micrognathia (e.g.

Pediatrics 40

Pediatrics Poisoning Hospitals Documentation/Coding 40

Don't Forget the Bubbles

JUNE 30, 2023

A recent review was conducted on Trauma Quality Improvement Program data between 2014 and 2016. These procedures require an experienced operator. These procedures require an experienced operator. These procedures require an experienced operator. 2014 Sep;45(9):1287-95. Really, in a 14-year-old? You are not sure.

Resuscitation 139

Resuscitation Operations Sepsis Pediatrics 139

PEMBlog

JUNE 5, 2024

2014 May;133(5):e1179-88. That’s a spine or neurosurgery operation. Leonard JR, Jaffe DM, Kuppermann N, Olsen CS, Leonard JC; Pediatric Emergency Care Applied Research Network (PECARN) Cervical Spine Study Group. Cervical spine injury patterns in children. Pediatrics. doi: 10.1542/peds.2013-3505. Baker C, Kadish H, Schunk JE.

Fractures 52

Fractures Pediatrics Radiology Radiology 52

EMDocs

SEPTEMBER 25, 2023

Improved Visualization: Video laryngoscopes allow for the use of standard or hyperangulated geometry, essentially allowing the operator to “look around the corner” on an anterior airway. Operators can manipulate the blade with less force to optimize the view, making it easier to identify and navigate the endotracheal tube into the trachea.

Emergency Department 79

Emergency Department Soft Tissue Injuries Airway Management Operations 79

Don't Forget the Bubbles

MAY 24, 2023

Airway complications are also more likely to occur in the emergency department (ED) than in the operating theatre. It can also able to be applied in multiple scenarios, not just the operating theatre, and it more accurately depicts real-world practice. 2014 Jan;42(1):169–78 Krishna SG, Bryant JF, Tobias JD. Why is it important?

Airway Management 98

Airway Management Pediatrics Teamwork Emergency Department 98

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. Erratum in Mouth-to-Airway [adjunct] 4/22/2014. Reviewed and revised 4 December 2014. Trimble, Tom, RN CEN. Advanced Emergency Nursing Blog.

Emergency Nursing 40

Emergency Nursing EMS Resuscitation Military 40

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

Don't Forget the Bubbles

JULY 5, 2023

Afro-Caribbean patients should be screened for sickle cell before anaesthesia for possible pre-operative transfusion. 2014; 349–356. In these cases, repeat the Hb electrophoresis three months after the last blood transfusion. What could be the differential diagnosis? The patient was diagnosed with Salmonella osteomyelitis.

Blood Transfusions 126

Blood Transfusions Stroke Dehydration Sepsis 126

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