Dr. Smith's ECG Blog

FEBRUARY 2, 2024

He did well and was discharged. Rituparna et al — as well as Chauhan and Brahma ( Int. Sci 5[4] 268-270, 2015 ) both highlight a likely association between acute development of ischemic J waves — and high risk of developing malignant ventricular arrhythmias ( My Comment in the September 23, 2020 post ). Smith’s ECG Blog ).

Hyperthermia / Hypothermia 138

Hyperthermia / Hypothermia EKG/ECG Wellness 138

The Trauma Pro

APRIL 26, 2024

A multi-center trial published in 2015 showed an astounding 32% mortality rate for patients with shock from pelvic fracture. Years ago, we tried to pack the pelvis from the inside (peritoneal cavity), but it never worked very well. As I continue to preach, going anywhere but the OR is dangerous for the patient.

Fractures 147

Fractures Head Injuries Radiology Radiology 147

The Trauma Pro

DECEMBER 26, 2023

Screening looks at patient factors such as age, obesity, and previous VTE, as well as injury risk factors like spine and pelvic fractures and decreased mobility. A meta-analysis of 13 studies published in 2015 showed that early ambulation was not associated with a higher incidence of new PE. Chest 127(5):1631-1636, 2005.

Documentation/Coding 124

Documentation/Coding Fractures Hospitals Research 124

The Trauma Pro

OCTOBER 6, 2023

At the time, there was a debate about whether the procedure should be done immediately versus waiting until the patient was well-resuscitated. This was a big procedure, with the possibility of several major complications, with postop paraplegia being one of them. The concern was that death was nearly certain if the aortic lesion progressed.

Head Injuries 147

Head Injuries Research Hospitals Resuscitation 147

The Skeptics' Guide to EM

FEBRUARY 22, 2020

Bringing value, balance and humanity to the emergency department: The Right Care Top 10 for emergency […] The post SGEM Xtra: Right, You’re Bloody Well Right, You’ve got the Bloody Right to Care first appeared on The Skeptics Guide to Emergency Medicine. Reference: Dorsett et al. How is it different from the Choosing Wisely Campaign?

Wellness 52

Wellness Emergency Department EMS 52

RebelEM

DECEMBER 17, 2024

You order antibiotics, an initial fluid bolus as well as blood cultures. One side argues that fever places additional physiological stress on patients, who are already ill ( Young 2015 ). On the other hand, fever may serve as a protective role by enhancing immune cell function and inhibiting pathogen growth and spread ( Young 2015 ).

Sepsis 55

Sepsis Shock EMS Emergency Department 55

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

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 113

EMS CPR EKG/ECG Wellness 113

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

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 74

EMS Outcomes Resuscitation Wellness 74

Don't Forget the Bubbles

JUNE 17, 2024

Riskin (2015) showed that rudeness accounted for a 12% reduction in diagnostic and procedural performance in a simulated resuscitation. Loss of psychological safety and mental well-being persist long after the episode and can impact future episodes of care. 2015 May;30:656-74. 2015 Sep 1;136(3):487-95. BMC medicine.

Leadership 105

Leadership Resuscitation Teamwork Patient Safety 105

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 Hospitals 105

Don't Forget the Bubbles

JANUARY 17, 2024

2015 But we all know that what happens in the lab does not always mirror what happens in real life. Point-of-care ultrasound may show well-demarcated, round, and hypoechoic material in the stomach and first part of the duodenum, though it can underestimate the number of beads present. ” ( Ed. After Darracq et al., Darracq, M.A.,

Pediatrics 111

Pediatrics Poisoning Ultrasounds Dehydration 111

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

Pediatric EM Morsels

OCTOBER 6, 2023

(Forster, 2021) Transmission is by Fecal-Oral route (Chiodini 2018) Incubation period 6-30 days after exposure (Chiodini 2018) Salmonella typhi produces an endotoxin although its clinical significance is not yet well understood (Gibani 2019) Two typhoid vaccines are available for those > 6 m/o and are 50-80% effective. Clin Infect Dis.

Pediatrics 161

Pediatrics CDC Seizures Documentation/Coding 161

Taming the SRU

OCTOBER 28, 2024

If their injury was from trauma, it would not be unreasonable to initiate trauma consult within the emergency visit, but also if the injury is isolated and the patient is well appearing, they could also follow up closely with the trauma clinic. 2015 Feb;7(Suppl 1):S44-9. 2015 May;166(5):1317-1317.e1. 2015 Mar;16(2):321-4.

COPD 78

COPD Pediatrics Emergency Department Ultrasounds 78

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

Dr. Smith's ECG Blog

FEBRUARY 6, 2024

Systolic function normal by visual assessment only, unable to visualize well for further characterization. The patient did well and was discharged. 2015, March 1). RV: Cavity size normal. 1900: RBBB and LAFB are almost fully resolved. 2300: QRS now within normal limits. No other significant injuries were found. Cramer, M.

EKG/ECG 114

EKG/ECG Wellness Fractures Hospitals 114

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 77

Hospitals Research Patient Safety Wellness 77

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

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

Taming the SRU

AUGUST 30, 2023

As the name would suggest, inflammatory markers are biological markers of, well, inflammation. A 2015 prospective, cross-sectional study of 78 Thai patients published in the International Journal of Rheumatic Disease demonstrated a sensitivity of 59% and specificity of 84% for PCT with a cut-off of 0.5 2015 Mar;18(3):352-9.

Infectious Diseases 88

Infectious Diseases Sepsis Emergency Department Point-of-Care Testing 88

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

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 96

EMS Resuscitation Blood Transfusions Seizures 96

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 129

Ultrasounds Outcomes COPD Hospitals 129

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

Don't Forget the Bubbles

SEPTEMBER 18, 2024

. ■ Case 1 focuses on a case seen in the emergency department and explores the common parental query of a “weak immune system” in a young child who has had several recurrent upper respirator tract infections back-to-back but is otherwise well. His parents are both fit and well and there is no family history of any medical conditions.

Emergency Department 78

Emergency Department Wellness Infectious Diseases Pediatrics 78

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

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

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

ALiEM

SEPTEMBER 27, 2023

What well-known adverse reaction results from ingestion of the pictured mushroom? Disulfiram-like reaction with ethanol consumption Coprinus atramentarius or Ink Cap mushroom is well known to cause a disulfiram-like reaction when it is consumed prior to ethanol. Encyclopedia of Toxicology (Third Edition), Academic Press. Goldfrank L.

Seizures 67

Seizures Academics Wellness 67

ALiEM

MARCH 7, 2024

It is usually large, nodular, well-defined, homogeneous, and slightly hypoechoic (Figure 13) [6]. 2015 [14] Case series in a pediatric ED, over a 2-year period N=8 5-17 years 8 cases of nephrolithiasis were identified with POCUS in patients presenting with renal colic. Am J Emerg Med. All patients had confirmatory imaging in radiology.

Ultrasounds 70

Ultrasounds Pediatrics Radiology Radiology 70

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 73

Hospitals Patient Safety Operations Wellness 73

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 82

Documentation/Coding Emergency Department Best Practices Federal Emergency Management Agency 82

EMDocs

JULY 9, 2024

Addressing social determinants of health at well child care visits: a cluster RCT. 2015 Feb;135(2):e296-304. Epub 2015 Jan 5. Epub 2015 Jul 14. Epub 2016 Nov 7. PMID: 27599265. Garg A, Toy S, Tripodis Y, Silverstein M, Freeman E. Pediatrics. doi: 10.1542/peds.2014-2888. PMID: 25560448; PMCID: PMC4306802. Acad Pediatr.

Pediatrics 55

Pediatrics Emergency Department Research Burns 55