Dr. Smith's ECG Blog

JULY 21, 2024

The patient in today’s case presented in cardiogenic shock from proximal LAD occlusion, in conjunction with a subtotally stenosed LMCA. Distinction of PMVT vs VFib is an academic one in this case ). LAD — 100% proximal occlusion; with 70-89% mid-vessel narrowing. RCA — 100% proximal occlussion. What About Procainamide?

EKG/ECG 131

EKG/ECG Shock Hospitals Sepsis 131

Taming the SRU

APRIL 17, 2024

3) Methods This study was a retrospective observational study at a single academic tertiary care facility in their medical intensive care unit (MICU). Surviving sepsis campaign: International Guidelines for Management of Sepsis and Septic Shock 2021. References Evans L, Rhodes A, Alhazzani W, et al. Crit Care Med. 2021;49:e1063-e1143.

Sepsis 94

Sepsis Research Stroke Academics 94

RebelEM

JUNE 8, 2023

Nontraumatic hypotension and shock in the emergency department and the prehospital setting, prevalence, etiology, and mortality: a systematic review. PMID: 36108346 Clinical Question: What is the efficacy and safety of peripherally administered push dose pressors for the treatment of acute hypotension? 2006;130(4):941–6. 2015;10(3):e0119331.

Administration 98

Administration Emergency Department Outcomes Documentation/Coding 98

Stop and Think

JUNE 13, 2023

It’s shocking how many have subscribed and supported this newsletter. One of my colleagues, a former academic, who is now in industry, tells me I shouldn’t have this chapter. Well, the authors of the smaller trial did not choose clinical outcomes, such as heart failure or death, as the primary endpoint.

Outcomes 98

Outcomes Academics Shock Hospitals 98

The Skeptics' Guide to EM

DECEMBER 11, 2021

. * Fujii et al ( VITAMINS RCT) JAMA 2020: n=216 patients with septic shock. Moskowits et al ( ACTS RCT) JAMA 2020: n=205 patients with septic shock. Dr. Rakesh Engineer Rakesh died suddenly in 2019 and the Society of Academic Emergency Medicine (SAEM) reflected upon how best to honour him. Rakesh Engineer.

Sepsis 40

Sepsis Shock Outcomes Research 40

RebelEM

DECEMBER 19, 2022

This procedure involves applying another set of pads attached to a second defibrillator to a patient and shocking them in hopes of terminating the rhythm. If you work in a tertiary academic center with a catheterization lab and/or ECMO immediately available, the application of a second defibrillator may not be immediately needed.

EMS 52

EMS CPR Shock Resuscitation 52

Don't Forget the Bubbles

MAY 6, 2024

The study included academic NICUs, which may reduce the generalisability of the results. While the use of oral corticosteroids to treat wheeze in asthma is well-established, evidence for their benefit in viral-induced wheeze is mixed. None of these changes were associated with an increased risk of severe TIAEs or desaturation.

Sepsis 75

Sepsis Pediatrics Outcomes Documentation/Coding 75

ACEP Now

SEPTEMBER 13, 2023

“We wanted to reach emergency physicians, nurses and others working in trauma as well as those at Health and Human Services and the Centers for Disease Control. as well as working closely on behalf of the association on projects with the White House and the Departments of Veterans Affairs, Defense, and Health and Human Services.

EMS 45

EMS Research Academics Military 45

PulmCCM

DECEMBER 3, 2023

academic centers received an additional sigh breath every 6 minutes. Well, that would be ground-breaking and practice-changing, to say the least. Patients were excluded if they had reasons for emergency intubation: respiratory distress, severe hypoxemia, vomiting, or shock.) vs 17.6%) in the sigh-ventilation group!

Poisoning 64

Poisoning Hospitals Outcomes Academics 64

PulmCCM

OCTOBER 30, 2023

Professional Medical Societies Call for Elimination of SEP-1 The Infectious Diseases Society of America (IDSA), along with societies for emergency medicine physicians and hospitalists, are again speaking up about the ongoing policy experiment known as the Centers for Medicare and Medicaid Severe Sepsis/Septic Shock Management Bundle (SEP-1).

Sepsis 52

Sepsis Shock Hospitals Infectious Diseases 52

Taming the SRU

MAY 3, 2023

Ultimately, on the cusp of deterioration, the patient was deemed most appropriate for transfer to a medical intensive care unit (MICU) at a large academic hospital via helicopter emergency medical services (HEMS). She was noted to have improvement in her underlying respiratory status as well and was extubated approximately three weeks later.

Wellness 52

Wellness Hospitals Shock Outcomes 52

RebelEM

MARCH 27, 2023

What They Did: Retrospective, observational cohort study in a single high-volume academic hospital The ED had a 5 bed area used for ongoing management and resuscitation of patients who clinically deteriorate while boarding or while actively undergo a workup in other sections of the ED. J Crit Care.

Emergency Department 52

Emergency Department Operations Academics Documentation/Coding 52

Dr. No

DECEMBER 6, 2021

In the limp language of academic writing, the authors suggest their findings ‘urge caution’ (sic) in interpretation of small differences, and that ‘bias-susceptible endpoints…should be used with care’ Translating into plain English, the masks don’t work, and the mandates should go.

Academics 52

Academics Outcomes Shock Wellness 52

Dr. Smith's ECG Blog

OCTOBER 6, 2023

This is one case where it made a difference: Right Ventricular MI seen on ECG helps Angiographer to find Culprit Lesion Nevertheless, it is sometimes a fun academic exercise to try to predict the infarct artery: An elderly patient had onset of chest pain one hour prior. His included cardiogenic shock, V Tach, AV block. He called 911.

EKG/ECG 66

EKG/ECG Academics Shock Outcomes 66

Stop and Think

OCTOBER 2, 2024

Well known is the fact that procedures put out a much stronger placebo effect than tablets. The first ORBITA trial shocked the cardiology world when it failed to find a placebo-resistant effect of stenting substantial coronary lesions. Academic Publishing I am now up to a modest 76 peer-reviewed co-authored papers.

Stroke 44

Stroke Academics Shock Ultrasounds 44

ALiEM

JULY 17, 2023

as well as an analysis of the 2023 Match by Pupazan and Cook in Emergency Medicine News [3,4]. Match Data The unprecedented numbers of unfilled PGY-1 EM residency training positions in the NRMP Match results shocked the specialty these last two years.

EMS 52

EMS Burns Emergency Department Shock 52

Dr. Smith's ECG Blog

NOVEMBER 26, 2018

The axiom of "type 1 (ACS, plaque rupture) STEMIs are not tachycardic unless they are in cardiogenic shock" is not applicable outside of sinus rhythm. For many reasons, including these: 1) The flutter waves of atrial flutter are well known to mimic ST deviations , as well as hide true ischemic ST deviations from the reviewer.

EKG/ECG 52

EKG/ECG Wellness Administration Academics 52

Dr. Smith's ECG Blog

JANUARY 5, 2020

Thus, both overdiagnosis and underdiagnosis of AF are well-recognized problems in computer interpreted electrocardiograms, and they adversely affect patient management with either inappropriate anticoagulation and/or antidysrhythmics or undertreatment [ 1 , 14 ]. Poon et al. sensitivity and 98.9%

EKG/ECG 52

EKG/ECG COPD Wellness Sepsis 52

Pediatric Emergency Playbook

MARCH 1, 2016

On arrival, he was in compensated shock, with tachycardia. Adults tolerate hypotension relatively well, and is sufficient until we send them to the OR or interventional radiology suite. Fox et al in Academic Emergency Medicine found a sensitivity of 52%; with a 95% confidence interval [CI] = 31% to 73%.

Resuscitation 40

Resuscitation Pediatrics Hyperthermia / Hypothermia Operations 40

EB Medicine

JULY 8, 2019

Jeff: Well that’s kind worrisome. Jeff: And while it’s not exactly core EM, we’re going to briefly discuss indications for bariatric surgery, as this is something we don’t often review even in academic training programs. Which again reiterates why this is such an important topic for us as EM clinicians to be well-versed in.

Emergency Department 40

Emergency Department Sepsis Operations Dehydration 40

Taming the SRU

AUGUST 30, 2023

As the name would suggest, inflammatory markers are biological markers of, well, inflammation. A 2011 meta-analysis in the journal of Academic Emergency Medicine found ESR, CRP, and PCT were not acutely useful in the diagnosis of septic arthritis due to wildly varying sensitivities and specificities between studies. Intensive Care Med.

Infectious Diseases 89

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

Don't Forget the Bubbles

DECEMBER 11, 2023

Naturally, it can seem obvious to us now that abuse and trauma in childhood can affect your health and well-being quite significantly, but what was surprising at the time was not just that these events had an impact but how much of an impact these adverse childhood events had. Could there be an element of causation as well as correlation?

Wellness 104

Wellness Research Outcomes Shock 104

ACEP Now

JANUARY 13, 2024

While these discriminatory and brutal acts were shocking, they were not surprising to Black people. Dr. Vanessa Grubbs, founder of Black Doc Village, articulates this well: “a white-dominated physician training system that unjustly excludes, punishes, and dismisses Black medical students, trainees, and attending physicians will continue on.”

Leadership 52

Leadership Academics Emergency Department Shock 52

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. However, IgE-mediated or not, anaphylactic shock is possible in either case. 8 The data in Mayer et al.

Stroke 105

Stroke Radiology Radiology Emergency Department 105

Don't Forget the Bubbles

AUGUST 13, 2023

After a short period of observation in the ED, he looks well and has been eating and drinking normally and playing. On examination she is febrile, well perfused with a CRT of less than 2sec, heart rate of 155 and respiratory rate of 35. The child is back to his normal self, febrile with a temperature of 38.60

Seizures 97

Seizures Pediatrics Dehydration Radiology 97

Don't Forget the Bubbles

FEBRUARY 24, 2025

They were a well-grown, term infant born in good condition. The condition increases blood viscosity and pulmonary vascular resistance, leading to pulmonary hypertension, haemodynamic collapse, and, ultimately, death due to hypoxaemia and refractory shock. The other investigations are unremarkable, including a normal CT head.

Pediatrics 59

Pediatrics Outcomes Blood Transfusions Sepsis 59

Taming the SRU

JUNE 6, 2023

then need further evaluation Usually with CTA imaging If normal physical exam & ABI>0.9, then need further evaluation Usually with CTA imaging If normal physical exam & ABI>0.9, then need further evaluation Usually with CTA imaging If normal physical exam & ABI>0.9,

Documentation/Coding 64

Documentation/Coding Seizures Psychiatric Wellness 64

Sensible Medicine

JANUARY 13, 2025

Yet, still, the vast majority (≈13 of 14) of patients implanted with an ICD for primary prevention never receive a shock, and therefore gain no benefit. Keep in mind that the ICD is a dumb device—as it saves lives by shocking a malignant arrhythmia back to normal. Plus, it’s in mortality, not a composite endpoint.

Evidence-Based Practice 95

Evidence-Based Practice Shock Academics Documentation/Coding 95

Emergency Medicine Journal

FEBRUARY 21, 2025

Methods We conducted a prospective observational study of adult and paediatric patients who suffered cardiac arrest in an academic hospital ED in central Haiti from January 2019 to August 2020. Survival may be impacted by limited resources for prearrest monitoring as well as for ongoing critical care. The mean age was 45 years; 55.9%

Outcomes 40

Outcomes Emergency Department Sepsis Academics 40

Sensible Medicine

SEPTEMBER 12, 2023

He is smart and has an impeccable academic pedigree. It might be about preventing cancer or maintaining cognitive function or achieving shocking longevity. The doctor is photogenic and usually male. The book is about a solution to a problem for which traditional medicine has little to offer.

Academics 139

Academics Shock Research Wellness 139