Dr. Smith's ECG Blog

OCTOBER 12, 2024

CTA head and neck were obtained and showed no evidence of intracranial hemorrhage, large vessel occlusion stroke (what a helpful and apt name for an acute arterial occlusion paradigm, by the way.), 2017 Sep-Oct;50(5):561-569. Epub 2017 Apr 19. Vital signs were within normal limits on arrival to the Emergency Department.

EKG/ECG 116

EKG/ECG Documentation/Coding Emergency Department COPD 116

PulmCCM

NOVEMBER 11, 2021

To focus matters, the hemodynamic variable under consideration is the stroke volume [SV]; in other words, how does a push of phenylephrine affect SV? ’ Diminished stroke volume? In the former group, stroke index [i.e., SV] increased significantly, while in the latter group, stroke index fell in response to phenylephrine.

Stroke 40

Stroke Sepsis Administration Wellness 40

Dr. Smith's ECG Blog

SEPTEMBER 2, 2024

mEq/L for Mg++ ) — given that ECF levels of these cations comprise only ~1-2% of total body stores ( Jahnen-Dechent and Ketteler — Clin Kidney J 5(Suppl 1):i3-i14, 2012 — and — Udensi and Tchounwou — Int J Clin Exp Physiol 4(3): 111-122, 2017 ). mEq/L for K+ and 1.76

Seizures 113

Seizures EKG/ECG EMS Stroke 113

Sensible Medicine

JULY 6, 2023

In short, the 41-month, placebo-controlled trial of nearly 14,000 statin-intolerant patients trial found: LDL decreased by 21% more in the bempedoic arm at 6 months 4-point MACE (CV death, MI, stroke, or coronary revascularization) was reduced by 1.6% (13.3% placebo vs 11.7% vs 8.6%) and elevated liver enzymes (4.5%

Outcomes 87

Outcomes Stroke Wellness 87

The Skeptics' Guide to EM

APRIL 6, 2019

He reports he has been taking apixaban to prevent stroke in the context of atrial fibrillation, which you easily recognize as one of the modern oral anti-Factor Xa inhibitors. The full study cohort of 503 patients has since been published ( Pollack et al NEJM 2017 ) and we are in the same place we were in 2015.

Stroke 52

Stroke Administration EMS Wellness 52

PulmCCM

APRIL 8, 2024

In a 2017 observational study at 43 French ICUs , gradual weaning was associated with less airway obstruction and gasping; families reported no greater incidence of PTSD symptoms after witnessing either type of extubation, while nurses reported more work stress with gradual weaning. If no significant structural heart disease (e.g.

Sepsis 40

Sepsis Stroke Hospitals Wellness 40

PulmCCM

JANUARY 22, 2024

The trial was later dubbed “TTM1” A 2017 trial (JAMA, n=355) did not find benefit in neurologic outcome with prolonged cooling to 33°C for 48 hours, but may have been underpowered (the intervention group had a nonsignificant absolute 5% improvement).

Hyperthermia / Hypothermia 80

Hyperthermia / Hypothermia Outcomes Research Hospitals 80

Taming the SRU

AUGUST 30, 2023

As the name would suggest, inflammatory markers are biological markers of, well, inflammation. 2017 Dec 14;9(6):7204-7218. They are used clinically to detect pathological inflammation or measure response to treatment [1-2]. days (secondary endpoint) [51]. Inflammatory responses and inflammation-associated diseases in organs.

Infectious Diseases 89

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

EB Medicine

AUGUST 6, 2019

Nachi: Specifically, we’ll be focusing on the use of DOACs for the indications of stroke prevention in atrial fibrillation and the treatment and prevention of recurrent venous thromboembolisms. Nachi: Well, I’m sure more of those studies are still coming. Show More v Jeff: Fair enough, we’ll take what we can get. Jeff: Agree.

Emergency Department 40

Emergency Department Stroke Wellness Resuscitation 40

Downeast Emergency Medicine

APRIL 26, 2021

MI or stroke). Secondary outcomes were early head injury related death (within 24 hours after injury), all-cause and cause-specific mortality, disability, vascular occlusive events (MI, stroke, DVT, PE), seizures, complications, neurosurgery, days of ICU care, and adverse events within 28 days. in the TXA group and 9.9%

Head Injuries 52

Head Injuries Administration Outcomes Seizures 52

Taming the SRU

MAY 3, 2023

She was noted to have improvement in her underlying respiratory status as well and was extubated approximately three weeks later. This targeted pulmonary vasodilation is thought to improve underlying ventilation-perfusion mismatch, leading to increased blood flow to already well-ventilated lung tissue (3).

Wellness 52

Wellness Hospitals Shock Outcomes 52

PulmCCM

JANUARY 24, 2024

The trial was later dubbed “TTM1” A 2017 trial (JAMA, n=355) did not find benefit in neurologic outcome with prolonged cooling to 33°C for 48 hours, but may have been underpowered (the intervention group had a nonsignificant absolute 5% improvement).

Hyperthermia / Hypothermia 52

Hyperthermia / Hypothermia Outcomes Hospitals Stroke 52

Pediatric Emergency Playbook

JUNE 1, 2017

This child is at risk for expected complications, as well as overdiagnosis and iatrogenia. These children depend on their preload to run blood passively into the pulmonary circuit; afterload reduction is also important to compensate for a poor left ejection fraction, as well as to avoid the development of pulmonary hypertension.

Pediatrics 52

Pediatrics EKG/ECG Wellness Seizures 52

ACEP Now

APRIL 2, 2024

They are found in large numbers in the mouth, throat, and stomach, as well as throughout the body. 8,9 There is one case of a 17-year-old who died from acute cerebellar stroke after participating in the “One Chip Challenge” (eating a capsaicin infused food chip as a game) that prompted Hershey Co. 2018:bcr-2017- 224085.

Burns 40

Burns Poisoning Seizures Stroke 40

EB Medicine

SEPTEMBER 1, 2018

Both are at the University of Florida Jacksonville, and they reviewed a total of 120 articles from 2006-2017, in addition to reviews from both Cochrane and Dare. Unfortunately, this myokymia may not respond to antivenom administration and myokymia of the chest well and torso can necessitate intubation in extreme cases.

Emergency Department 40

Emergency Department Poisoning Anaphylaxis Allergic Reactions 40

EB Medicine

MAY 3, 2019

The PSS-3 assesses for depression/hopelessness and suicidal ideations in the past 2 weeks as well as lifetime history of suicide attempt. Jeff: a 2017 ACEP clinical policy also recommends against routine lab testing in those with acute psychiatric complaints. Nachi: The next tool to discuss is the ED-Safe PSS-3.

Emergency Department 40

Emergency Department Psychiatric Documentation/Coding Outcomes 40

EMDocs

JULY 3, 2023

National Institutes of Health Stroke Scale (NIHSS) is 13; vital signs include pulse 86 beats/minute (bpm), blood pressure 164/94 mmHg, and saturation of 98% on room air. 14 The American Stroke Association (ASA) and American Heart Association (AHA) recommend SBP <160 mmHg until definitive management of the bleed is completed.

Seizures 98

Seizures Stroke Outcomes EMS 98

Don't Forget the Bubbles

AUGUST 21, 2023

The baby’s parents tell you that the baby hasn’t been feeding well for a few days and today has been very sleepy. Stimulation of baroreceptors results in a catecholamine-mediated increase in heart rate , stroke volume, contractility, and systemic vascular resistance (SVR). What are your differentials? Bad bronchiolitis ?

Pediatrics 98

Pediatrics Outcomes Research Sepsis 98

The Skeptics' Guide to EM

APRIL 3, 2021

mg/kg) was beneficial for unknown onset stroke above a certain core size. 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. A SRMA was published by Mistry et al Stroke 2017.

Stroke 52

Stroke Research Outcomes Emergency Department 52

RebelEM

FEBRUARY 22, 2024

as well as their primary outcome confidence interval certainly limits the overall confidence in the trial results. PMID 37952133 Clinical Question: In patients with acute myocardial infarction and anemia, does a restrictive or liberal transfusion strategy affect the risk of death or recurrent myocardial infarction at 30 days? Type 1: 41.7

Blood Transfusions 58

Blood Transfusions Outcomes Wellness Research 58

Dr. Smith's ECG Blog

APRIL 8, 2015

True Syncope: If, on the other hand, the patient is well, had no other serious symptoms , has a normal sinus rhythm, and normal physical exam , then you need to be certain the syncope was not due to a dangerous brady- or tachydysrhythmia that could recur. Vasovagal syncope is generally benign. g/dL —Hypotension (obviously!) Sivilotti, M.,

Emergency Department 52

Emergency Department EKG/ECG Outcomes Seizures 52

Northwestern EM Blog

JANUARY 3, 2022

Published 2017 May 10. Although most of these injuries would not be considered emergent, correct diagnosis and referral of these patients is important to keep them active and decrease their likelihood of suffering the heart attacks, strokes, and chronic pain we see daily. Petraglia F, Ramazzina I, Costantino C. A systematic review.

Fractures 52

Fractures EMS Urgent Care Stroke 52

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 ). Acute Pain in Children".

Pediatrics 40

Pediatrics Soft Tissue Injuries Burns Emergency Department 40

EMDocs

NOVEMBER 13, 2023

2 Outcomes of patients presenting with ischemic stroke who received MRI as initial imaging modality have demonstrated similar outcomes to those with initial CTA, with Kim et al. Stroke Authors’ Recommendation: CTA head/neck should be acquired in patients with stroke symptoms presenting within 24 hours of symptom onset.

Stroke 105

Stroke Radiology Radiology Emergency Department 105

EMDocs

NOVEMBER 4, 2024

million patient complaints in 2017, making it the second most common ED complaint. She denies any trauma, swelling, or redness in the joints, as well as fever or weight loss. National Hospital Ambulatory Medical Care Survey (NHAMCS) 2017 Emergency Department Summary Tables (2017). 2017 Apr 4;166(7):514-530.

Emergency Department 105

Emergency Department Fractures Burns EMS 105

PulmCCM

FEBRUARY 26, 2024

Tenecteplase for acute ischemic stroke presenting after 4.5 Because it can be infused more rapidly than alteplase, TNK is gaining prominence as thrombolytic treatment for acute ischemic stroke, in patients presenting within 4.5 hours of their last time known to be well. hours after the onset of stroke).

Stroke 40

Stroke Psychiatric CDC Hospitals 40

Don't Forget the Bubbles

JULY 5, 2023

SCD, therefore, is not only a mechanical disease but there are also many other cellular and plasma factors as well as endothelial interaction that generate chronic inflammation. Recent studies have shown that low-dose ketamine can reduce pain in acute painful crises of sickle cell patients as well as being an opioid-sparing drug.

Blood Transfusions 126

Blood Transfusions Stroke Dehydration Sepsis 126

Pediatric EM Morsels

NOVEMBER 15, 2024

There are associated co-morbiditiested [Lee 2017, Steinrueke 2023] BECTS Seizures / Benign Rolandic Epilepsy- Moral of the Morsel It’s not a stroke, it’s a seizure. Symptoms can be unilateral and involve the face and tongue, but it’s not a stroke! 2017 Jun 30;7(1):1-6. Available from: [link] Lee YJ, Hwang SK, Kwon S.

Seizures 154

Seizures Stroke Pediatrics Wellness 154

Dr. Smith's ECG Blog

FEBRUARY 20, 2025

Moreover, it does not follow a coronary distribution very well. The QTc looks prolonged ( well over half the R-R interval ) although accurate QTc assessment becomes challenging at this rapid a rate. By ECG alone: it is suspicious for stress cardiomyopathy, or takotsubo, due to the diffuse ST Elevation: II, III, aVF AND I and aVL.

EKG/ECG 89

EKG/ECG Resuscitation EMS Seizures 89

PulmCCM

FEBRUARY 3, 2025

Theoretical harms from excessive oxygen therapy include absorption atelectasis, acute lung injury, inflammation and tissue damage mediated by reactive oxygen species, as well as central nervous system, cerebrovascular and cardiovascular toxicity. Almost all the trials were published between 2005 and 2017, with only three before 1990.

Sepsis 52

Sepsis Stroke Outcomes Hospitals 52

PulmCCM

JANUARY 2, 2025

Conclusions Numerous randomized trials, most of them small and at risk for bias, previously suggested that procalcitonin-guided antibiotic discontinuation resulted not only in reduced antibiotic exposure in severe illness, but a tendency toward lower mortality as well. How reliable is this body of evidence? fewer days of antibiotics.

Sepsis 98

Sepsis Outcomes Stroke Shock 98

EB Medicine

DECEMBER 1, 2018

Nachi: And just last year we saw the 2017-2018 influenza epidemic with record-breaking ED visits. The 2017-2018 vaccine was only 40% effective, but this still translates to 40% less severe cases and a subsequent decrease in hospitalizations and death. This was the deadliest season since 1976 with at least 80,000 deaths. Nachi: Amazing.

Emergency Department 40

Emergency Department CDC Infectious Diseases EMS 40

Don't Forget the Bubbles

NOVEMBER 18, 2024

Neonatal hypotension can result from inadequate cardiac output, low systemic vascular resistance, or a combination of both, which are influenced by: Cardiac Output: Neonates, particularly preterm ones, may have compromised cardiac output due to myocardial immaturity, leading to reduced stroke volume and heart rate. El-Khuffash, A.

Sepsis 59

Sepsis Shock Hyperthermia / Hypothermia Administration 59

PEMBlog

MAY 9, 2024

2017 Jul;70(1):52-62.e6. Epub 2017 Mar 2. Well, they are the most common neurologic disorder of infants and young children, and they happen in about 2 to 4 percent of children between the ages of 6 months and 5 years of age. And interestingly, they’re usually about the same length as well. Ann Emerg Med.

Seizures 59

Seizures Pediatrics Wellness Emergency Department 59

EMDocs

JANUARY 6, 2025

She receives IV calcium gluconate and bicarbonate as well as oral potassium binders for hyperkalemia. These patients suffer from untreated physical injuries, including gunshot wounds, shrapnel, accidents, envenomations, sequelae of physical or sexual assault, and heat exhaustion/heat stroke. Hypoglycemia is managed with IV dextrose.

Infectious Diseases 75

Infectious Diseases CDC PPE Rapid Diagnostic Testing 75