Dr. Smith's ECG Blog

AUGUST 18, 2024

The patient was found to have a fractured lead, which was replaced successfully without complications and with resolution of symptoms. He did well. No P wave and no QRS ever follows any of the regular pacing spikes ( a result of the fractured pacing lead ). Smith: this can usually be seen on chest x-ray.

EKG/ECG 110

EKG/ECG Fractures Burns Wellness 110

RebelEM

FEBRUARY 24, 2025

Well, the established cutoff for the distensibility index is 18%. just be careful with pelvic fractures or any femoral arterial punctures/ devices. Mar 2023; PMID: 36983218 Feissel M, et al. Apr 2023; PMID: 37009935. Why does it matter? This has a pooled sensitivity of 89% and specificity of 91%.just Di Nicol P, et al.

Ultrasounds 74

Ultrasounds Shock Fluid Resuscitation Resuscitation 74

ALiEM

OCTOBER 30, 2024

The Wounds Common among patients who use xylazine, the necrotic and exudative wounds are still not fully understood [5-8], but are likely due in part to direct cytotoxic effects of the drug and its impurities, as well as possible nutritional deficiencies common in those with dependence. 2023 Jan 1;53(1):140-2. 2022; 06/26/2023.

Emergency Department 64

Emergency Department Operations Psychiatric EMS 64

Broome Docs

APRIL 6, 2023

2023 Jan 21. 2023 Feb;64:206.e1-206.e3. 2023 Jan 30. Immobilisation of torus fractures of the wrist in children (FORCE): a randomised controlled equivalence trial in the UK. 2023 Jan 13;76(2):185-191. 2023 Feb 03;: PMID: 36367144 Justin’s excellent critical appraisal and Full write up here.

Sepsis 52

Sepsis Ultrasounds Hospitals Fractures 52

The Trauma Pro

SEPTEMBER 15, 2023

Typical ones include hemorrhagic injuries to the brain, pelvic and spine fractures, and solid organ injuries. Bottom line: Seeing such a well-designed and nicely executed study is refreshing. AAST 2023, Plenary paper #23. Typically, VTE prophylaxis starts immediately upon admission. A prospective AAST multi-institutional trial.

Administration 113

Administration Fractures Wellness 113

Pediatric EM Morsels

JULY 7, 2023

Evaluating the limping child , though, requires us to ponder not only the common (ex, Toddler’s Fracture ), but also to be vigilant for the severe (ex, Septic Arthritis ). Seen in sports that involved aggressive twisting of the knee (ex, snowboarding, soccer, horse-riding) as well as direct trauma.

Dislocations 143

Dislocations Fractures Pediatrics EMS 143

Emergency Medicine Journal

NOVEMBER 28, 2023

Aims and Objectives Rib fractures account for over 15% of all trauma attendances in the Emergency Department. Among patients with multiple rib fractures, the mortality rate can reach a staggering 33%, and this risk doubles for individuals above the age of 65. ED Physicians are already well-versed in the use of ultrasound.

Fractures 40

Fractures Anaphylaxis Emergency Department Ultrasounds 40

Don't Forget the Bubbles

JUNE 30, 2023

She has a right parietal-occipital region haematoma, and you think you might be able to feel a step – you’re pretty convinced she has a palpable skull fracture. Well, one study in Kornelson’s systematic review and meta-analysis is interesting. 2023 Jun 14. Two IVs go in, one in each antecubital fossa. Acad Emerg Med.

Head Injuries 145

Head Injuries Seizures Pediatrics Outcomes 145

ALiEM

SEPTEMBER 13, 2024

On arrival to our emergency department, the patient expressed continued eye pain with bloody discharge as well as blurry vision from his right eye. Laboratory Data CT Orbits/Sella w/ IV Contrast : No acute orbital fracture. 2023, March 23). Visual acuity: able to count fingers. Extraocular movements intact. Eye (Lond).

Emergency Department 64

Emergency Department Fractures Academics Hospitals 64

RebelEM

APRIL 29, 2024

CVC vs PIV The critically ill patient is often associated with pathology that makes IV access difficult such as shock state, hypovolemia, obesity, IV drug abuse, end-stage renal disease, cardiac arrest, as well as other conditions. World J Emerg Surg 2023 PMID: 36918947 3. 2023 PMID: 37502742 11 Schwalbach KT et al. Healthcare.

Resuscitation 105

Resuscitation Administration Emergency Department Ultrasounds 105

EMDocs

JUNE 8, 2024

Orbital wall fractures: palpate bony structures surrounding the eye, check extra ocular muscle movements to rule out entrapment, obtain CT imaging if suspected [7]. 2023, www.uptodate.com/contents/overview-of-eye-injuries-in-the-emergency-department?search=traumatic+iritis&source=search_result&selectedTitle=2~150&usage_type=default&display_rank=2.

EMS 98

EMS Allergic Reactions Poisoning Emergency Department 98

Taming the SRU

NOVEMBER 14, 2023

A thorough trauma history and physical exam should be performed including evaluation for bony fracture in the surrounding structures of the face. Therefore, both of these should be important considerations as well when evaluating swollen ears in the emergency department. Accessed November 9, 2023. Facial Plast Surg.

Emergency Department 94

Emergency Department Pediatrics Wellness Fractures 94

Don't Forget the Bubbles

OCTOBER 19, 2023

Dani gave this talk at the Irish Association of Emergency Medicine Annual Scientific Conference in October 2023 Once upon a time, there were two beautiful people, Barbie and Ken. You diagnose community-acquired pneumonia and tell Barbie and Ken that Bee’s well enough to have some antibiotics at home – and you’d like to give her amoxicillin.

Head Injuries 81

Head Injuries Fractures Outcomes Hospitals 81

Taming the SRU

OCTOBER 16, 2024

Pregnant patients are inherently higher risk for VTE, and because of this are excluded from normal clinical decision tools like Wells Criteria that would normally be able to help guidance our clinical decisions. Patients are unable to actively flex their DIP and x-ray imaging often will reveal and avulsion fracture.

Airway Management 74

Airway Management Fractures CDC Pediatrics 74

Don't Forget the Bubbles

JULY 31, 2023

Our team have scoured what’s new (well, mostly new!) 2023 May 31;12(5):290-297. Pediatric Emergency Care March 15, 2023. | Radiographs from children with fractures, or disease processes affecting bone growth, were excluded. 2023 Jun 25. 2023 May;182(5):2205-2214. Epub 2023 Mar 3. Eur J Pediatr.

Rapid Diagnostic Testing 98

Rapid Diagnostic Testing Resuscitation Emergency Department Pediatrics 98

ACEP Now

OCTOBER 30, 2023

Remove all braces, prosthetics, and clothing, check the undersurfaces and intertriginous areas, look for bruising or fractures, evaluate all indwelling devices (tracheostomy sites, gastrostomy-jejunostomy tubes, foleys, peripherally-inserted central catheter lines and ports), and inspect nail beds, ears, and teeth. Accessed October 10, 2023.

Sexual Assault 98

Sexual Assault Teamwork Dehydration Outcomes 98

ACEP Now

FEBRUARY 11, 2024

The clavicle is one of the most commonly fractured bones in the human body. Every year, approximately 332,000 people in the United States suffer from a clavicular fracture. The clinician should note the fracture site (either via palpable landmark or ultrasound visualization). Click to enlarge.) for the ED clinician.

Ultrasounds 52

Ultrasounds Fractures Emergency Department Hospitals 52

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. Ann Emerg Med 2017 [6] This was a retrospective database review of 7521 traumatic brain injury patients SBP target ≥90mmHg resulted in a mortality of 7.8%

Resuscitation 145

Resuscitation Fluid Resuscitation Head Injuries Shock 145

Sensible Medicine

MARCH 14, 2024

These suspicions are not baseless as a 2023 Elsevier survey suggests a majority of trainees are struggling to imagine themselves shouldering a career in direct patient care. I’ve heard arguments that frame this discussion in terms of trainee wellness, physician burnout, social contract, and patient outcomes. The result?

Hospitals 100

Hospitals Wellness Fractures Academics 100

Taming the SRU

OCTOBER 1, 2023

This topic is additionally complicated by the development of multiple diagnostic tools now available for diagnosis as well as variable sizing algorithms used around the world. Blunt trauma can cause rib fracture or dislocation that may injure the visceral pleura. 89% of patients with PTX under this cutoff were successfully observed.

Fractures 96

Fractures COPD Hospitals Emergency Department 96

Taming the SRU

JANUARY 1, 2024

Contraindications to placing an IO include a prior attempt at the same site, known orthopedic fracture or local hardware, overlying skin infection, and structural bone disease such as osteogenesis imperfecta (6). An IO is a temporary solution and should be removed within 24 hours to avoid increased risk of infection such as osteomyelitis.

Emergency Department 92

Emergency Department Ultrasounds Administration Burns 92

Don't Forget the Bubbles

OCTOBER 10, 2024

2023 Mar 30;110(4):432-438. The study excluded complex nail bed injuries, including those with distal phalanx fractures, germinal matrix injury or pulp lacerations, meaning outcomes are only relevant to simple nail bed injuries. 2024 Jul 10:archdischild-2023-326727. doi: 10.1136/archdischild-2023-326727. Arch Dis Child.

Emergency Department 75

Emergency Department Outcomes Research Operations 75

ACEP Now

MAY 6, 2023

Vehicle occupants wearing seatbelts may sustain injury to the cervical spine as a result of abrupt deceleration as well as blunt trauma to the chest, abdomen, and pelvis. Clavicular and humeral fractures are more common in passengers than in drivers. Updated January 20, 2023. Accessed April 3, 2023. Accessed 4/3/23.

Forensics 52

Forensics Documentation/Coding Head Injuries Fractures 52

Taming the SRU

APRIL 22, 2023

If untreated, atrial fibrillation can increase clot formation and lead to an increased risk for heart attack and stroke as well as development of congestive heart failure. Additionally, a higher HR reduction at 30 and 60 minutes, as well as ED discharge/transfer. TamingtheSRU.

Outcomes 52

Outcomes Stroke Fractures Documentation/Coding 52

Taming the SRU

AUGUST 30, 2023

As the name would suggest, inflammatory markers are biological markers of, well, inflammation. 2023 Feb 2;388(5):439-452. Updated 2023 Apr 24]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. 2023 Jul 10. Treasure Island (FL): StatPearls Publishing; 2023 Jan–. Updated 2023 May 8]. Fibrinogen.

Infectious Diseases 89

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

Mind The Bleep

OCTOBER 17, 2024

Official statistics from 2023 from SMR tell us the majority of our callouts are trauma, with lower leg and ankle injuries accounting for 57% of callouts. Medics have much to offer teams in various aspects of the above, but the ability to help with the day-to-day tasks is important. Where, might you say, is the role of the doctor?

Soft Tissue Injuries 52

Soft Tissue Injuries Seizures Ambulance Services Teamwork 52

Taming the SRU

FEBRUARY 5, 2024

Several definitions have been set forth for this common injury, with perhaps the most well accepted definition being introduced by the Centers for Disease Control and World Health Organization. The history should focus on both the events surrounding the traumatic event, as well as current symptomatology. 5, 2023, pp.

Head Injuries 59

Head Injuries Emergency Department Seizures Pediatrics 59

ACEP Now

MARCH 14, 2024

These can be delayed, up to weeks later, so it’s important to educate patients on the importance of follow-up with burn care well-versed with electrical injuries or neurology if they have or develop these symptoms. 2023 Jul 17. Treasure Island (FL): StatPearls Publishing; 2023 Jan– PMID: 28846317. Accessed October 21, 2023.

Burns 52

Burns Fluid Resuscitation EKG/ECG EMS 52

PulmCCM

FEBRUARY 12, 2024

Then in 2023, ATS and ESICM released separate, conflicting ARDS guidelines: ESICM did not recommend steroids for ARDS in its guidance, while ATS did. SCCM joined neither ATS nor ESICM’s 2023 ARDS guideline update. In 2017, ATS, SCCM, and ESICM together issued a joint guideline for the management of ARDS.

Shock 52

Shock Administration Sepsis Fractures 52

Don't Forget the Bubbles

OCTOBER 2, 2024

A previously well 6-year-old boy is brought into the emergency department at a major trauma centre via HEMS following a road traffic accident, in which he was hit by a car while crossing the road. He is diagnosed with a traumatic brain injury and a fracture to his right tibia and fibula. 2023 [cited 2024 Apr 10].

Administration 49

Administration Pediatrics Outcomes Research 49

EMDocs

FEBRUARY 22, 2025

Well keep it short, while you keep that EM brain sharp. Certain types of skull fractures can cause the dura mater to tear, creating communication between the subarachnoid space, the paranasal sinuses, and the middle ear. Updated 2023 Mar 6]. Management of CSF leak in base of skull fractures in adults. Interv Neuroradiol.

EMS 66

EMS Fractures Operations Wellness 66

EMDocs

JUNE 3, 2023

How should pelvic fractures be identified in unstable trauma patients? Pelvic fractures can involve disruptions in any of the bony or ligamentous structures of the pelvic ring. Due to the round shape of the pelvic ring, multiple fractures typically occur concurrently. 2 Vertical shear fractures are also unstable.

Fractures 64

Fractures Resuscitation Operations EMS 64

Taming the SRU

MARCH 11, 2024

It is also important for the emergency physician to ask about previous surgeries on the affected knee, as well as anticoagulation status. CTAs have the added benefit of also further evaluating the surrounding osseus structures for associated fracture.

Dislocations 108

Dislocations Emergency Department Fractures Operations 108

Don't Forget the Bubbles

JULY 22, 2024

Using a score that’s not used in clinical practice may seem like it reduces the applicability of the findings, but ultimately, the authors have translated the studies to the well-established PRAM score. 2023 Dec;78(12):1175–80. 2023 Sep 9 [cited 2024 Jan 30];62(suppl 67). Cochrane; 2023 [cited 2024 Apr 15]. N Engl J Med.

Outcomes 105

Outcomes Research Pediatrics Hospitals 105

Don't Forget the Bubbles

JULY 17, 2023

2023 Jun;38(6):1733-1751. 2023 May 16;28(3):172-183. 2023 Jun 6;28(4):205-251. 2023 Jun 6;28(4):252-266. 2023 Jun 1;177(6):559-560. Original clinical studies Distribution and pattern of hand fractures in children and adolescents. 2023 Jun;182(6):2785-2792. 2023 May 16;28(3):184-202. 2023 Jun 1.

Pediatrics 98

Pediatrics Emergency Department Outcomes Fractures 98

EMDocs

NOVEMBER 13, 2023

2019) argue against a minimum NIHSS score to trigger the use of CTA, instead purporting that clinical suspicion of acute ischemic stroke presenting within 24 hours of the last known well was sufficient evidence to order the study. 23 BCVI should be suspected with any high-energy trauma or any fractures of the maxilla or mandible.

Stroke 105

Stroke Radiology Radiology Emergency Department 105

EMDocs

NOVEMBER 4, 2024

Costochondritis, rib fractures, and pericarditis are common causes of chest pain that can be treated with multimodal regimens. 7 Rib and Sternal Fractures: Rib fractures are often caused by blunt chest trauma. Up to two-thirds of rib fractures are missed on initial chest radiographs. Most cases abate by one year.

Emergency Department 105

Emergency Department Fractures Burns EMS 105