Dr. Smith's ECG Blog

MARCH 10, 2025

They concluded, "Our findings increase confidence in the normal automated GE Marquette 12 SL ECG software interpretation to predict a benign outcome. Smith comment: this is a very stupid outcome measure) What if we use that methodology for the ECG above? What is the gold standard for ECG interpretation: patient outcome!!!

EKG/ECG 89

EKG/ECG Outcomes Documentation/Coding Emergency Department 89

EMDocs

JANUARY 8, 2024

Author: Brit Long, MD (@long_brit) // Reviewed by Alex Koyfman, MD (@EMHighAK) The American Heart Association 2023 Guideline Updates for 2023 were just published. Magnesium does not improve ROSC, survival, or neurologic outcomes, no matter the presenting rhythm (Level 3: no benefit). 2023 Dec 18. Circulation.

Seizures 98

Seizures Shock CPR Hyperthermia / Hypothermia 98

EMDocs

JANUARY 11, 2025

May 18, 2023) Stercoral Colitis: A Diagnostic Challenge and Therapeutic Approach in an Elderly Patient With Chronic Constipation. Stercoral Colitis in the Emergency Department: A Retrospective Review of Presentation, Management, and Outcomes. Fecal Impaction and Nonperforated Stercoral Colitis: Red Flags for Poor Outcomes.

EMS 98

EMS Sepsis Shock Fluid Resuscitation 98

EMDocs

DECEMBER 1, 2024

The disease is generally mild, but in untreated cases, it can lead to more severe outcomes, especially in patients with underlying conditions such as glucose-6-phosphate dehydrogenase deficiency. Even though the disease often resolves spontaneously, prompt antibiotic therapy is essential for optimal outcomes. 2023 Oct 26;15(6):700-716.

EMS 105

EMS Infectious Diseases Shock Airway Management 105

Don't Forget the Bubbles

MAY 17, 2023

2023 Apr 17. 2023 Apr 25;329(16):1386-1398. 2023 Apr 29. 2023 Apr 24. 2023 Apr 12. 2023 Apr 28. 2023 Apr 25. 2023 Apr 25. 2023 Apr 25. 2023 Apr 24. 2023 Apr 18:S0890-8567(23)00185-5. 2023 Apr 24. 2023 Apr 21. 2023 Apr 20:fetalneonatal-2022-324835.

Pediatrics 72

Pediatrics X-Ray Interpretation Sepsis Fractures 72

Pediatric EM Morsels

JULY 21, 2023

Motor Fingernail bed pressure with a pencil first If flexion outcome, then apply painful stimulus to neck or head (trapezius or supraorbital notch) to look for localization Spinal reflex can result in a falsely elevated score if lower extremity pain induced Verbal Orientated- Able to answer all questions. 1976 May 15;1(7968):1031-4.

Head Injuries 246

Head Injuries Pediatrics Outcomes Shock 246

PulmCCM

DECEMBER 11, 2023

Sepsis, infectious disease Managing septic shock with a restrictive-fluids approach (preferentially using vasopressors after a single liter crystalloid bolus) led to similar outcomes as the usual practice of bolusing large volumes of fluids first. Vitamin C did not improve outcomes among patients hospitalized with Covid-19.

Sepsis 94

Sepsis Stroke Shock Infectious Diseases 94

RebelEM

JUNE 29, 2023

Back on June 1 st , 2023, Swami wrote a blog post on REBEL EM titled, The CT FIRST Trial, Should We Pan-CT After ROSC? REBEL EM Blog, June 1, 2023. Diagnostic yield, safety, and outcomes of Head-to-pelvis sudden death CT imaging in post arrest care: The CT FIRST cohort study. Resus 2023.

CPR 145

CPR EMS Documentation/Coding Outcomes 145

The Skeptics' Guide to EM

JULY 2, 2023

Date: July 1, 2023 Reference: PATCH-Trauma Investigators and ANZICS Clinical Trial Group. Date: July 1, 2023 Reference: PATCH-Trauma Investigators and ANZICS Clinical Trial Group. Most of the times the RCTs we critically appraised did not demonstrate superiority for their primary outcome.

EMS 145

EMS Outcomes Hospitals Research 145

Emergency Medicine Journal

JANUARY 21, 2025

This study compares the treatment outcomes of HDICS as add-on therapy to the outcomes of standard treatment in adult patients with acute asthma exacerbation in the ED. Methods This was a single-centre, triple-blind, randomised controlled trial conducted in the ED in Thailand between March 2022 and April 2023.

Hospitals 52

Hospitals Outcomes 52

Ken Grauer, MD

SEPTEMBER 21, 2024

To quote Dr. Stephen Smith: "The worst risk factor for a bad outcome in acute MI is young age." . = PEARL # 3: Acute MI Can Occur in a Younger Patient! Smith's ECG Blog — with links at the bottom of this post to a series of more cases illustrating this phenomenon ). That said — acute MI does occur in younger patients.

EKG/ECG 296

EKG/ECG Resuscitation Outcomes Hospitals 296

Stop and Think

DECEMBER 26, 2023

My Choice for Top Cardiology Story of 2023 Obesity Treatments: Here is what I wrote : Hyperbole is almost impossible when describing the potential benefits of the glucagon-like peptide-1 (GLP-1) receptor agonists. Semaglutide reduced cardiovascular outcomes in patients with established cardiovascular disease and obesity but without diabetes.

Outcomes 75

Outcomes 75

The Trauma Pro

DECEMBER 22, 2023

The reality is that no one will ever be able to design a study that definitively evaluates the very soft outcomes that result from using this technique. 1485, Dec 2023. It can help direct the surgical exploration if imaging was unnecessary or contraindicated. So yes, this is dogma.

Operations 264

Operations Outcomes 264

The Skeptics' Guide to EM

SEPTEMBER 9, 2023

New England Journal of Medicine June 2023 Date: July 19, 2023 Guest Skeptic: Dr. Casey Parker is a Rural Generalist that includes in his practice emergency medicine, anesthesia, and critical care. New England Journal of Medicine June 2023 Reference: Snelling et al. He is also a fully-fledged ultrasonographer.

Fractures 139

Fractures Ultrasounds Pediatrics Outcomes 139

Total Medical ComplianceHIPAA

APRIL 14, 2023

On April 11, 2023, the HHS published a notice on upcoming new rules to add greater protection to reproductive health care because of new state laws passed due to the outcome of the Supreme Court ruling on Roe v. You should always keep the “minimum necessary” rule in mind whenever you are giving out information.

Documentation/Coding 83

Documentation/Coding Outcomes Wellness 83

Pediatric EM Morsels

NOVEMBER 17, 2023

Differences in intubation outcomes for pediatric patients between pediatric and general Emergency Departments. Intubation practice and outcomes among pediatric emergency departments: A report from National Emergency Airway Registry for Children (NEAR4KIDS). 2023 Apr 28;24(3):579-587. That sounds reasonable, so what has changed?

Pediatrics 187

Pediatrics Emergency Department Outcomes Sepsis 187

Pediatric EM Morsels

JUNE 9, 2023

Banc-Husu, 2023 ] Cholestastis Inflammatory conditions Genetic and Metabolic diseases Pediatric cirrhotic liver disease has many complications. Banc-Husu, 2023 ; Luoto, 2020; Carneiro de Moura, 2018 ] Basics are best (always)! 2023 Feb;43(1):100-116. Portal Hypertension in children is a heterogenous disease ]. Semin Liver Dis.

Pediatrics 154

Pediatrics Head Injuries Airway Management Administration 154

PulmCCM

JANUARY 15, 2025

According to a 2023 analysis of applications for FDA approval , as late as 2020 manufacturers were complying with a minimum of effort—e.g., Clinical Outcomes Associated With Overestimation of Oxygen Saturation by Pulse Oximetry in Patients Hospitalized With COVID-19. JAMA Network Open 2023. Nature (news). January 2024.

Academics 81

Academics Documentation/Coding Administration Research 81

Pediatric EM Morsels

AUGUST 9, 2024

Hussain, 2023 ] Leads to >300,000 perinatal deaths / year globally. Congenital syphilis differs from syphilis contracted by an “adult” in that: [ Hussain, 2023 ] T. Hussain, 2023 ] Excellent prognosis if treated early. If not treated early, then increased risk of poor outcomes and death. Epub 2023 Aug 18.

Hyperthermia / Hypothermia 154

Hyperthermia / Hypothermia Emergency Department Seizures Pediatrics 154

RebelEM

JUNE 1, 2023

Post-ROSC management is nuanced and challenging but helps to ensure good outcomes. In theory, rapid identification of the underlying cause should improve outcomes by allowing clinicians to tailor management. Diagnostic yield, safety, and outcomes of Head-to-pelvis sudden death CT imaging in post arrest care: The CT FIRST cohort study.

Outcomes 145

Outcomes Resuscitation Hospitals CPR 145

The Skeptics' Guide to EM

DECEMBER 16, 2023

AEM Dec 2023 Date: December 14, 2023 Guest Skeptic: Dr. Chris Bond is an emergency medicine physician and assistant Professor at the University of Calgary. AEM Dec 2023 Date: December 14, 2023 Guest Skeptic: Dr. Chris Bond is an emergency medicine physician and assistant Professor at the University of Calgary.

Emergency Department 128

Emergency Department Research Outcomes 128

EMDocs

NOVEMBER 13, 2024

Older age, recurrent episodes of SBP, hepatorenal syndrome, hepatic encephalopathy, acute kidney injury (AKI), concurrent GI bleeding, and higher MELD scores are predictors of worse outcomes. 2023 Aug;70:84-89. Spontaneous bacterial peritonitis in patients with cirrhosis: incidence, outcomes, and treatment strategies.

Hyperthermia / Hypothermia 105

Hyperthermia / Hypothermia Ultrasounds Shock Hospitals 105

The Skeptics' Guide to EM

JUNE 3, 2023

Date: June3, 2023 Reference: Kotani et al. Journal of Critical Care April 2023 Guest Skeptic: Dr. Amber Gombash is an emergency physician in Concord, NC. Date: June3, 2023 Reference: Kotani et al. Journal of Critical Care April 2023 Guest Skeptic: Dr. Amber Gombash is an emergency physician in Concord, NC.

Outcomes 111

Outcomes Wellness 111

The Skeptics' Guide to EM

OCTOBER 21, 2023

Date: October 20, 2023 Reference: Cai et al. AEM October 2023. Date: October 20, 2023 Reference: Cai et al. AEM October 2023. AEM October 2023. Implementation of a Clinical Management Tool for Spinal Epidural Abscess Early Diagnosis. Reference: Cai et al.

Emergency Department 135

Emergency Department Radiology Radiology Hospitals 135

The Skeptics' Guide to EM

JANUARY 6, 2024

July 2023 Date: Dec 11, 2023 Guest Skeptic: Dr. Rachel Hatcliffe is a pediatric emergency medicine attending at Children’s National Hospital in Washington, DC. July 2023 Date: Dec 11, 2023 Guest Skeptic: Dr. Rachel Hatcliffe is a pediatric emergency medicine attending at Children’s National Hospital in Washington, DC.

Emergency Department 137

Emergency Department Pediatrics Anaphylaxis Leadership 137

RebelEM

MAY 29, 2023

Crit Care 2023. Limited, small studies on its use in septic shock do not make a clear argument for use. Paper: Ibarra-Estrada, M et al. Early Adjunctive Methylene Blue in Patients with Septic Shock: A Randomized Controlled Trial. NaCl over 6hrs once daily x3 doses Placebo: 500mL of 0.9% 95% CI 15.4 95% CI 15.4 95% CI 15.4 95% CI 15.4

Shock 145

Shock Fluid Resuscitation Sepsis Resuscitation 145

RebelEM

FEBRUARY 15, 2024

not a patient oriented outcome) Single country study which may limit generalizability Excluded pregnancy where risk of emesis is increased due to gravid uterus Alcohol was the implicated in the overwhelming majority of patients. Paper: Freund Y et al. References: Freund Y et al.

Poisoning 141

Poisoning Airway Management Seizures Shock 141

RebelEM

JUNE 26, 2023

Interventions such as early application of hemorrhage control, tranexamic acid, reduction of crystalloid fluid administration and balanced ratio blood product transfusion have improved many patients’ outcomes. However, mortality still remains high due to trauma-induced coagulopathy. Severe acute traumatic coagulopathy = PT >1.5

Administration 143

Administration Outcomes Resuscitation Radiology 143

The Skeptics' Guide to EM

NOVEMBER 11, 2023

Date: November 2, 2023 Reference: Coventry et al. Aug 2023 Guest Skeptic: Dr. Matt Schmitz is an Orthopaedic Surgeon who sub-specializes in adolescent sports and hip preservation. Date: November 2, 2023 Reference: Coventry et al. Which clinical features best predict occult scaphoid fractures? Emerg Med J. Emerg Med J.

Fractures 131

Fractures Military Radiology Radiology 131

RebelEM

MAY 27, 2024

The primary outcomes are patient-centered and objectively measured, potentially ensuring relevance and reliability. The unblinded nature of the study could influence outcomes due to observer bias. Employing P-values to compare demographics between groups could mislead interpretations of the data’s relevance to the primary outcomes.

Outcomes 137

Outcomes Research Operations Hospitals 137

PulmCCM

SEPTEMBER 21, 2023

A 2015 meta-analysis of 13 randomized trials enrolling >12,000 patients suggested that active blood pressure management after ischemic strokes had little effect on eventual outcomes, and that delaying blood pressure control for three days did not lead to worse outcomes (death or disability).

Stroke 105

Stroke Outcomes 105

RebelEM

SEPTEMBER 14, 2023

to 1.03) Poor Neurologic Outcome (CPC 3 or 4): 24.8% to 1.03) Poor Neurologic Outcome (CPC 3 or 4): 24.8% to 1.03) Poor Neurologic Outcome (CPC 3 or 4): 24.8% The benefits of this strategy may be outweighed by the risk of the device-related complications (i.e. bleeding, stroke, limb ischemia, and hemolysis). Zeymer HT et al.

Shock 136

Shock Outcomes Resuscitation Stroke 136

Don't Forget the Bubbles

JUNE 30, 2023

The primary outcome was 28-day mortality – TXA improved survival with no increased risk of cerebral clots. Survival was better, both at 24 hours and six months, in the TXA group, although the primary outcome, a quality of life score at six months, called the Glasgow Outcome Scale Extended (GOS-E), was the same in both groups ( 53.7%

Head Injuries 145

Head Injuries Seizures Pediatrics Outcomes 145

Emergency Medicine Journal

DECEMBER 30, 2024

Background Calls to emergency departments (EDs) from ambulances to alert them to a critical case being transported to that facility that requires a special response (‘pre-alerts’) have been shown to improve outcomes for patients requiring immediate time-critical treatment (eg, stroke).

Emergency Department 52

Emergency Department Stroke Documentation/Coding Outcomes 52

EMDocs

AUGUST 5, 2023

Source Diagnostic yield, safety, and outcomes of Head-to-pelvis sudden death CT imaging in post arrest care: The CT FIRST cohort study. 2023 Jul;188:109785. Epub 2023 Apr 3. #2: Source Adverse Clinical Outcomes Among Patients With Acute Low-risk Pulmonary Embolism and Concerning Computed Tomography Imaging Findings.

Resuscitation 91

Resuscitation Outcomes Hospitals 91

EMDocs

NOVEMBER 29, 2023

2023 May 25;388(21):1931-1941. Included 584 patients > 18 years admitted to ICU with severe PNA based on IDSA/ATS criteria Primary Outcome: 60-day all-cause mortality Hydrocortisone 16% vs. placebo 18%, adjusted OR 0.90 (95% CI 0.57-1.40) 2023 Jul 8;27(1):274. 2023 May 31;27(1):212. #4: 2023 Jul;188:109785.

Resuscitation 98

Resuscitation Outcomes EKG/ECG 98

EM Ottawa

NOVEMBER 6, 2023

Lancet 2023 Jul 1;402(10395):27-40. Question and Methods: Do 6 month outcomes improve after implementation of a goal-directed care bundle that corrects prognostically poor physiological abnormalities (systolic hypertension, fever, hyperglycemia, abnormal anticoagulation) for acute intracranial hemorrhage?

Outcomes 107

Outcomes 107