Dr. Smith's ECG Blog

SEPTEMBER 11, 2024

Hope you’re doing well! The American Journal of Emergency Medicine 2015; 33(6):786-790. You taught us well!" Most of these Q waves are unusually wide with respect to QRS amplitude in the lead being looked at — as well as fragmented in multiple leads, including lead V3 ( BLUE arrow ) and leads III, aVF, V2 and V4.

EMS 117

EMS CPR EKG/ECG Wellness 117

RebelEM

MAY 25, 2023

CRYSTALLOIDS Too much crystalloid resuscitation in traumatic hemorrhagic shock can increase dilutional coagulopathy, as well as increase morbidity and mortality Bickell WH et al. British Journal of Anaesthesia 2015. vs SBP target <90mmHg which resulted in a mortality of 33.4% NEJM 1994. [2] PMID: 28559036 Holcomb JB et al.

Resuscitation 145

Resuscitation Fluid Resuscitation Head Injuries Shock 145

ALiEM

FEBRUARY 26, 2024

Otherwise, he was well-appearing, acting normally, and eating/voiding/stooling normally. Additional Images Physical Exam General : Well appearing, acting appropriately for age HEENT : Scalp normal. 2015 Mar-Apr;60(2):211. The patient presented with a vesicular rash on his face including around his eyes. Pediatr Dermatol.

Academics 78

Academics Pediatrics Wellness 78

ALiEM

APRIL 12, 2023

The thin alcohol layer serves to eliminate any air bubbles under the adhesive cover as well as minimizes residual adhesive material sticking to the probe when removing the cover. The adhesive cover itself serves as a sterile barrier and a slick surface to improve probe maneuverability. Accessed April 5, 2023.

Ultrasounds 103

Ultrasounds Emergency Department Resuscitation Wellness 103

RebelEM

APRIL 29, 2024

In these situations, the American Heart Association (AHA) and the European Resuscitation Council (ERC) of 2015 recommend the intraosseous (IO) route after the peripheral route and before the central venous route ( 1). 2015 PMID: 25768683 8 Leidel BA. This can often lead to significant delays in proper resuscitation. Trauma 1996.

Resuscitation 105

Resuscitation Administration Emergency Department Ultrasounds 105

Don't Forget the Bubbles

JULY 19, 2023

Olivia, a previously well 13-year-old girl, is referred to the paediatric ED from the Ophthalmology ED. 2015 ) found an incidence of true papilloedema of 25% and 6%, respectively, in children referred to tertiary ophthalmology departments with suspected optic disc swelling. 2015 Aug 1;19(4):344–8. 2023 and Kovarik et al.,

Pediatrics 98

Pediatrics Emergency Department Outcomes Wellness 98

EMDocs

FEBRUARY 7, 2024

Unionization of healthcare providers can create opportunities to improve staff’s financial and general well-being, but may also facilitate future strikes. Trainees and attending providers should be informed about both the opportunities that come with unionization, as well as the challenges that come with managing strikes.

Hospitals 89

Hospitals Research Patient Safety Wellness 89

ACEP Now

SEPTEMBER 11, 2023

While summitting Carstensz in Indonesia in October 2015, he and his wife led a Wild Med Kilimanjaro Expedition and summited Kili in March 2016. He also became close friends with Chris Imray, a vascular surgeon and leading frostbite expert, on that 2015 Indonesia climb, and they reconnected to summit Mt.

Wellness 126

Wellness 126

Don't Forget the Bubbles

JUNE 30, 2023

20 (2015): 1898-1908 As the PICU reg finishes their teaching and prescribes some warm IV fluids, Elsa’s sats drop to 54%. The ECMO team are on their way… Three hours later, Elsa’s gases are better, her PEEP is down to 8, and she’s oxygenating well on 80% oxygen. Christensen, Vinay M. Nadkarni, Kathleen L. Meert et al. Meert et al.

Hyperthermia / Hypothermia 145

Hyperthermia / Hypothermia Military CPR EKG/ECG 145

EMDocs

JUNE 22, 2024

The newborn is doing well, but the mother is complaining of shortness of breath and chest pain. 2015 May;28(7):793-8. A 37-year-old G5P4 at 33 weeks presents to the ED after being brought in by ambulance. She had a precipitous delivery while the ambulance was pulling in. Triage vital signs (VS) include BP 88/45, HR 121, T 97.1,

EMS 107

EMS Resuscitation Blood Transfusions Seizures 107

RebelEM

SEPTEMBER 23, 2024

However, it is well-established that even a single dose of etomidate can cause adrenal suppression ( Albert 2011 ). Opponents of ketamine often point to the risks of spiking intracranial pressure but this concern has been widely debunked ( Cohen 2015 ). Ann Emerg Med 2015; 65(1): 43-51. Intensive Care Med. 2011;37(6):901-910.

EMS 65

EMS Outcomes Resuscitation Wellness 65

RebelEM

APRIL 17, 2023

However, It is unclear how well POCUS performs in ruling in or ruling out the diagnosis of PTA. Question: How well does the US perform in diagnosing PTA compared to CT, needle aspiration, or Incision and Drainage? 2015 May;204(5):1064-8. Article: Kim DJ et al. Acad Emerg Med. 2023 Jan 10. Epub ahead of print. PMID: 36625850.

Ultrasounds 129

Ultrasounds Radiology Radiology Operations 129

EMDocs

DECEMBER 14, 2023

If a physician is allowed to be on call for more than one hospital – or to be in the OR when on call – define the procedure for simultaneous calls as well as when a surgeon is operating. Reference : See similar case in “ Where ’ s all that blood coming from” in the November 2015 issue of MMI-LFL. Patient dies in ED.

Hospitals 85

Hospitals Patient Safety Operations Wellness 85

EMDocs

AUGUST 22, 2024

have limited English proficiency according to the 2015 U.S. Well-meaning providers who are not highly fluent may contribute to miscommunication and diagnostic errors. Providers should respect and utilize this mode of communication, as well as document the patient’s request for a non-certified interpreter. Lion KC, et al.

Documentation/Coding 94

Documentation/Coding Emergency Department Federal Emergency Management Agency Best Practices 94

Pediatric Emergency Playbook

OCTOBER 1, 2016

Well appearing? Consider allergic proctocolitis if the child is well. Think -- pink stain, without clot: Infants and Young Children Well appearing? Pitfalls in the infant and young child Epistaxis; food-related misadventures Older Child and Adolescent Well appearing? Neonates Well appearing? 2015 Jul;17(7):27.

Pediatrics 52

Pediatrics Wellness Shock Resuscitation 52

Taming the SRU

JUNE 24, 2024

Conduction Abnormalities AV blocks, which can also be seen in patients with MI, may require pacing as well, due to ischemia affecting the electrical pathways of the heart. MedEdPORTAL Publications; 2015. Circulation , vol. 1103–1104, [link] Cousar J, Bohanske M, Hill J. Transvenous Cardiac Pacemaker Educational Resource.

Advances Cardiac Life Support (ACLS) 89

Advances Cardiac Life Support (ACLS) CPR Burns Resuscitation 89

Taming the SRU

JULY 24, 2023

Risk factors associated with increased risk of acute perforated cholecystitis include age greater than 65 years old, as well as diabetes mellitus, atherosclerosis, or organ failure (1, 2). The most well-accepted classification of acute perforated cholecystitis is the Niemeier classification which is outlined as below (3,6).

Ultrasounds 78

Ultrasounds Sepsis Radiology Radiology 78

American Medical Compliance

JANUARY 9, 2024

trillion in 2015. More than 3,900 cases of medical identity theft involving patients and providers were recorded in 2015, according to the most recent FTC data, with over 10,000 cases reported between 2013 and 2015. As a result of their large size, these healthcare systems are easy targets for fraud. Learn more below.

Wellness 52

Wellness 52

The Skeptics' Guide to EM

APRIL 6, 2019

This changed in 2015 when the Food and Drug Administration (FDA) approved idarucizumab for the reversal of dabigatran. We covered the interim analysis of 90 patients included in a prospective cohort study by Pollack et al NEJM 2015 on SGEM#139. Dabigatran is a direct thrombin inhibitor.

Stroke 52

Stroke Administration EMS Wellness 52

ALiEM

MAY 19, 2023

A heavy alcohol drinker, who is well known to your Emergency Department, presents with altered mental status, except that he looks different this time. Published July 13, 2015. He looks really bad, stating that he has been vomiting blood. He is hypotensive. He then vomits a copious amount of blood right in front of you.

Emergency Department 98

Emergency Department Ultrasounds Wellness EMS 98

The Skeptics' Guide to EM

SEPTEMBER 16, 2017

There is no well-established treatment algorithm other than airway control if the angioedema is severe and appears to be causing a mechanical obstruction and cessation of the medication. A 2015 phase 2 study published in the NEJM (Bas et al) touted the role for icatibant in the treatment of these patients.

Anaphylaxis 52

Anaphylaxis Administration EMS Emergency Department 52

RebelEM

JANUARY 25, 2024

CHF, in particular, lends itself well to diagnosis and treatment with PoCUS, as it readily reveals the presence of B lines. 2015 Oct;50(4):480-7. Epub 2015 May 22. Furthermore, the serial US group included more patients with conditions detectable with US. vs. 18.3%). vs. 74%), consolidation (37.3% J Pain Symptom Manage.

Ultrasounds 122

Ultrasounds Outcomes COPD Hospitals 122

Taming the SRU

MAY 23, 2023

BACKGROUND Foot injuries are common and can have significant implications for a patient’s well-being, functional capacity, and finances. Use your exam to guide your initial management as well as your imaging decisions and differential diagnosis. 2015 Apr 28]. 2015 Dec;8(1):76. Epub 2015 Jul 25. Calcaneus fractures.

Fractures 57

Fractures Dislocations Operations EMS 57

The Skeptics' Guide to EM

SEPTEMBER 12, 2020

I have discussed burnout and wellness a number […] The post SGEM Xtra: The Water is Wide first appeared on The Skeptics Guide to Emergency Medicine. Mayo Clin Proc 2015 * Shanafelt et al. I was invited by the College of Physicians and Surgeons of Ontario (CPSO) to give a talk at their council meeting on burnout. Shanafelt et al.

Emergency Department 52

Emergency Department Wellness 52

Sensible Medicine

AUGUST 14, 2024

In popular (lay) understanding, SIDS represents a common danger that a well-cared for and apparently healthy baby will suddenly and terrifyingly be found dead in the morning. The sudden death of an apparently healthy child is a devastating tragedy, and if it’s preventable, the costs of supine sleep may be worthwhile.

CDC 95

CDC Sepsis Research Pediatrics 95

American Medical Compliance

APRIL 10, 2023

Rise in Cases of Sexual Harassment There were 4,738 cases of improper sexual conduct reported from 2005-2015. This empowers victims to step forward with these allegations as well as show others that they are not alone. Individuals are making connections and empowering change throughout the industry.

Hospitals 52

Hospitals Wellness 52

Sensible Medicine

AUGUST 7, 2024

A 2015 Nature (Pediatric Research) paper by Nils J. There is evidence that, for children and adults, elevated cortisol levels and chronic stress can lead to behavioral, mental-health, and mood issues, as well as changes in inflammation and immunity. To receive new posts and support our work, consider becoming a free or paid subscriber.

CDC 107

CDC Documentation/Coding Research Pediatrics 107

ALiEM

MAY 13, 2024

They may be well-circumscribed or may have irregular borders. Well-circumscribed abscess with heterogeneous debris C. Larger abscess with well-circumscribed borders D. Superficial abscess with well-circumscribed borders Table 1. Epub 2015 Nov 10. The rim may be echogenic or blend in with surrounding tissue.

Ultrasounds 64

Ultrasounds Pediatrics Emergency Department Wellness 64

Don't Forget the Bubbles

DECEMBER 13, 2023

Susan had issues initially with ensuring the correct latch, but after a review with a lactation consultant, feeding is going well. Though it has been hard, they have been coping well and enjoying parenthood. First and foremost, do they look well or unwell? Epub 2015 Dec 9. At the 6-week check, Luke is 3.54 Eur J Pediatr.

Dehydration 98

Dehydration CDC Hospitals Wellness 98

Taming the SRU

MAY 22, 2023

Use your exam to guide your initial management as well as your imaging decisions and differential diagnosis. Fracture incidence in adults in relation to age and gender: A study of 27,169 fractures in the Swedish Fracture Register in a well-defined catchment area. 2015 Dec;8(1):76. Epub 2015 Jul 25. 12): e0244291.

Fractures 77

Fractures Dislocations Operations Radiology 77

Maria Yang, MD

MARCH 18, 2024

To try to answer the perennial question I ask myself (“what am I doing?”), I recently read this 2015 article, What is mental health? Maybe “well” versus “unwell”? It is more common to hear “I’m physically doing well,” rather than “My physical health is high.”) As a psychiatrist 1 , do I treat mental illness?

Psychiatric 52

Psychiatric Hospitals Wellness 52

Dr. No

DECEMBER 1, 2021

The way to get round this slippery data problem, as regular readers of this blog will know only too well, is to look at all cause mortality. Well, Dr No did try a bit of figuring, by looking at all cause deaths by age band in recent years, downloaded from this page. Just as it seems a strand is emerging, it slithers away again.

Forensics 52

Forensics Wellness Operations 52

Taming the SRU

JULY 13, 2023

F The patient was a well-appearing male who was awake, alert and oriented. 2015;34(4):2015. Cardiopulmonary, abdominal and neurologic examinations were normal. The head was atraumatic. The right eye appeared proptotic, with mild conjunctival injection. Arch Ophthalmol. 2000;118(3).

Dislocations 91

Dislocations Hospitals Wellness 91

Northwestern EM Blog

MAY 9, 2022

There is no gold standard with respect to its definition, and it requires a medication history (which we typically don't do very well in the emergency department). 12 March 2015. NMS is hard to diagnose because it's rare. A tricky cause of NMS is the removal of a dopamine agonist. References 1. Institute for Safe Medication Practices.

Hyperthermia / Hypothermia 52

Hyperthermia / Hypothermia Fluid Resuscitation Psychiatric Administration 52

Don't Forget the Bubbles

FEBRUARY 19, 2024

The Role of Gaming in Emotional Well-being Stress Relief: Gaming can be a form of relaxation and stress relief, providing an escape from the pressures of daily life. There is a complex interplay between gaming, psychological needs, and adolescent well-being. It can offer a safe environment to unwind and engage in enjoyable activities.

Academics 59

Academics Leadership Research Teamwork 59

EMDocs

NOVEMBER 1, 2023

ECG – May show tachycardia or rate related ST depressions Laboratory evaluation: CBC w/ differential – may reveal leukocytosis with left shift CMP, Lipase – can reveal alternative intra-abdominal diagnoses as well as show findings of end-organ hypoperfusion (elevated serum creatinine, transaminitis, etc.) McGraw-Hill Education; 2015.

Operations 78

Operations Radiology Radiology Fluid Resuscitation 78

EMDocs

DECEMBER 18, 2024

2015; 17(6): 1-19. fold higher risk of NSTI than the control group 12 For those without comorbidities , AUD exhibited a 15.2-fold Br J Addict. 1989; 84(11): 1353-1357. Yanta J, Swartzentruber G, Pizon A. Alcohol withdrawal syndrome: improving outcomes through early identification and aggressive treatment strategies. Emerg Med Pract.

Seizures 99

Seizures Hyperthermia / Hypothermia Emergency Department EMS 99