Dr. Smith's ECG Blog

JANUARY 5, 2024

Written by Willy Frick A 46 year old man with a history of type 2 diabetes mellitus presented to urgent care with complaint of "chest burning." Smith comment: No patient over 25 years of age with unexplained chest burning should be discharged without a troponin rule out, no matter how normal the ECG. The following ECG was obtained.

EKG/ECG 123

EKG/ECG Burns Urgent Care Documentation/Coding 123

ACEP Now

NOVEMBER 7, 2024

Hydrogel dressings are preferred for minor burns, partial- and full-thickness wounds, wounds with necrosis, and deep wounds with tunneling or sinus tracts. They should be avoided in dry wounds (arterial ulcers) or necrotic wounds with an eschar. Examples include Mepilex, Tegaderm, and Optifoam. They can remain in place for up to seven days.

Burns 97

Burns Documentation/Coding Outcomes Emergency Department 97

Ken Grauer, MD

JULY 22, 2023

The ECG in Figure-1 was obtained from an elderly man with a history of coronary disease — who contacted EMS for "burning" chest discomfort that woke him at 3am. Not only is this slight ST elevation missing from leads V2,V3 in ECG #1 — but the ST segment in these leads ( as well as in neighboring leads V1; and V4,V5 ) is distinctly flat!

EKG/ECG 195

EKG/ECG Burns EMS Wellness 195

Pediatric EM Morsels

AUGUST 11, 2023

Having authored 575 ( well, now 576 ) of them, I am often quite convinced that there are no new topics to discuss. This is the 601st Ped EM Morsel ! Then July happens and we get 14 more amazing interns who help educate me and remind me that there is always more to learn.

Burns 130

Burns Pediatrics EMS Outcomes 130

Northwestern EM Blog

MAY 2, 2022

There is lower quality evidence for reduced myocardial infarction and mortality risk as well. In fact, HBOT is primarily used to reduce associated cognitive, behavioral, and neurologic changes (collectively known as delayed neuropsychiatric sequelae). However, several factors limit HBOT use.

Burns 52

Burns Poisoning EKG/ECG Operations 52

American Medical Compliance

APRIL 15, 2024

Child abuse and neglect are unfortunately pervasive issues that can have long-lasting impacts on a child’s health and well-being. Therefore, this serious form of abuse can have profound and lasting effects on a child’s emotional and physical well-being.

Burns 95

Burns Wellness Outcomes 95

Dr. Smith's ECG Blog

DECEMBER 3, 2024

This was written by one of our fine residents, who will soon be an EMS fellow: Michael Perlmutter Case A mid-50s male came to the ED with a burning sensation that was acutely worse while at home. When pressed, he endorsed mild, very brief periods of a retrosternal burning sensation and serial ECGs were obtained. Mobitz II is not.

EKG/ECG 113

EKG/ECG Burns Wellness Shock 113

Ultrasound Gel

SEPTEMBER 28, 2022

Well listen in to the discussion of this interesting randomized controlled trial designed to answer this burning question. Well listen in to the discussion of this interesting randomized controlled trial designed to answer this burning question. Should we be using POCUS to guide nasogastric tube placement?

Burns 52

Burns Wellness 52

Dr. Smith's ECG Blog

AUGUST 18, 2024

He did well. Burns and Buttner — LITFL ( Life-In-The-Fast-Lane ) — in the June 4, 2021 and July 7, 2022 posts. The QRS shows LVH and there are diffuse ST-T abnormalities likely in part appropriate for the LVH, though memory T waves are also a consideration. Smith: this can usually be seen on chest x-ray.

EKG/ECG 113

EKG/ECG Fractures Burns Wellness 113

Taming the SRU

FEBRUARY 7, 2024

Vaughan SJS/TEN and DRESS are life-threatening drug reactions that require immediate discontinuation of the drug and specialist involvement In SJS/TEN, if >10% skin involvement or worsening symptoms, transfer the patient to a Burn Center DRESS has characteristic multi organ involvement, so a high level of suspicion for complications should be maintained (..)

Administration 98

Administration PPE Ultrasounds Poisoning 98

Don't Forget the Bubbles

SEPTEMBER 11, 2024

I have been a doctor for half of my life, and my journey to burnout has been a 25-year slow burn that began the day I graduated. Focusing on the job in front of them became harder, and this sense of depletion lasted well beyond leaving the office. But after every great burn, there is a space for growth. That I was not fine.

Burns 88

Burns Hospitals Emergency Department Wellness 88

Taming the SRU

DECEMBER 17, 2024

Other conditions that lead to intravascular fluid depletion include but are not limited to starvation/dehydration, vomiting, diarrhea, burns/trauma, hyperglycemia, and hemorrhage. Out of 18 patients receiving ORT, 4 failed to respond well and were escalated to IV therapy. Oral intake is the most preferred method for receiving fluids.

Dehydration 83

Dehydration Fluid Resuscitation Administration Resuscitation 83

Medagadget

OCTOBER 31, 2023

This brings us to the burning question: does it work? It works pretty well, especially with the up-to-40X digital amplification. But what’s more critical is the ability to visualize and analyze data in real-time, as well as the options to record, save data, and share data. In short, yes.

EKG/ECG 90

EKG/ECG Burns Wellness Telemedicine 90

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. Skin burns and irritation can also result from the pacing pads and cause pain. Sedation can be adequately achieved with benzodiazepines.

Advances Cardiac Life Support (ACLS) 89

Advances Cardiac Life Support (ACLS) CPR Burns Resuscitation 89

Mind The Bleep

FEBRUARY 2, 2025

This is a tricky area to cover as it can be challenging to us both personally and professionally when things dont go well with a colleague, particularly when we know that this might impact patient care and/or our own mental health. A simple sentence like This interaction hasnt gone well. Can I just check if everything is ok with you?

Documentation/Coding 98

Documentation/Coding Outcomes Burns Wellness 98

The Skeptics' Guide to EM

OCTOBER 31, 2020

She is the host of EM Bootcamp in Las Vegas, as well as a usual speaker and faculty member for The Center for Continuing Medical Education (CCME). She is the host of EM Bootcamp in Las Vegas, as well as a usual speaker and faculty member for The Center for Continuing Medical Education ( CCME ).

Burns 52

Burns Emergency Department EMS Wellness 52

Taming the SRU

NOVEMBER 4, 2023

D Thompson and Goel C-spine Imaging: NEXUS is a large, well-done study validating criteria for low-risk of cervical injury that are easy to remember and use at the bedside, and is used in our clinical decision guidelines on AgileMD. Eschars can form quickly and cause limited expansion of the torso and compartment syndrome of the extremities.

Hyperthermia / Hypothermia 84

Hyperthermia / Hypothermia Resuscitation Burns Emergency Department 84

Taming the SRU

AUGUST 27, 2024

This differential is broad and reflects the clinical diversity of their presentations - in this post we will parse through the specifics of bullous lesions as well as what there is to do for them acutely.

Emergency Department 83

Emergency Department Dehydration Burns Sepsis 83

Taming the SRU

JANUARY 1, 2024

However, in at least 10% of patients, blind insertion of a peripheral IV may be unsuccessful for a variety of reasons including obesity, edema, IV drug use, surgical scars, dialysis, burns, and others (1,2). In this post, we will review multiple alternative sites and techniques available for establishing peripheral access.

Emergency Department 91

Emergency Department Ultrasounds Administration Burns 91

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. Studies have compared IO to peripheral intravenous (PIV) and central venous (CVC) access for resuscitation.

Resuscitation 105

Resuscitation Administration Emergency Department Ultrasounds 105

American Medical Compliance

JUNE 4, 2024

It is not merely a physical response but involves emotional and psychological aspects as well. Pain can be sharp, dull, throbbing, or burning. Characterized by a shooting or burning sensation, neuropathic pain often follows a nerve pathway and can be continuous or intermittent. O stands for onset, meaning when the pain started.

Burns 52

Burns Outcomes Wellness 52

ACEP Now

AUGUST 15, 2023

While there has been ample discussion of “the practice of mindfulness” in health care workers that improves mental well-being, when do we have this time? However, expressing genuine gratitude for yourself and others is powerful for your mental and physical well-being. However, they should not define our wellness. Acta Clin Belg.

Emergency Department 90

Emergency Department Military Resuscitation Wellness 90

RebelEM

AUGUST 7, 2023

This helps relieve agitation/pain while maintaining spontaneous breathing and airway reflexes allowing for adequate pre-oxygenation as well as facilitates other resuscitation interventions including IV access, vasopressors, fluids, etc. that would not be possible in an agitated/combative patient.

Head Injuries 94

Head Injuries Airway Management Outcomes Burns 94

ALiEM

FEBRUARY 9, 2024

Pulses are well felt in all four limbs. She would be low risk by gestalt or structured scoring systems (Wells or revised Geneva), and a negative D-dimer would essentially rule out pulmonary embolism here. The discomfort has a burning character, though he has never been diagnosed with reflux before. It started 2 hours ago.

EKG/ECG 110

EKG/ECG Emergency Department Burns Wellness 110

ACEP Now

OCTOBER 10, 2024

On physical exam, you notice what appears to be a blister from a burn on her right palm (see photo on cover). When you are done, you tell the mother what you found and ask her if there is any way the child could have been burned. The child should be undressed, and the exam conducted in a well-lit room.

Forensics 40

Forensics Domestic Violence Burns Pediatrics 40

Taming the SRU

AUGUST 4, 2024

We discussed some practices to push learners outside of their comfort zone and promote learning, based on their level as well as their goals for the shift.

Dislocations 85

Dislocations Emergency Department Documentation/Coding Burns 85

ACEP Now

APRIL 2, 2024

degress Fahrenheit), caustics (low pH), and voltage—causing a Ca++ and Na+ action potential influx that confers the sensation of pain and burning to the brain. They are found in large numbers in the mouth, throat, and stomach, as well as throughout the body. Referral for ophthalmology for patients with signs of corneal damage.

Burns 40

Burns Poisoning Seizures Stroke 40

ACEP Now

AUGUST 29, 2023

Our program pairs training at one of the busiest emergency departments in the country at a nationally recognized county, safety-net, Level I Trauma and Regional Burn Center (MetroHealth) with a world-renowned quaternary academic referral center (Cleveland Clinic). What does your program offer that residents can’t get anywhere else?

Academics 52

Academics Burns Emergency Department Ultrasounds 52

EM Curious

MAY 14, 2015

ER Cast BURN THIS INTO YOUR MEMORY BLOATED & UPSET [BLOG POST]: An excellent imaging case regarding x-ray findings that should concern you in a patient presenting with abdominal pain, bloating and vomiting. Is CT only in 6 hours is ready for prime time? Listen here. Do you know the causes of methemoglobinemia?

Ultrasounds 52

Ultrasounds Poisoning EMS Burns 52

Emergency Medicine Ireland

DECEMBER 3, 2020

All that being said it’s worth being aware that there are some major pieces of guidance out there and you would do well to have a passing correspondence with them. I would highly recommend attending an excellent lecture given by your ICU dietician which is just possibly where this entire summary came from.

Burns 52

Burns Sepsis EMS Wellness 52

Sensible Medicine

MAY 31, 2023

Her outpatient follow-up appointments were scheduled; we had reviewed her safety plan; she felt well and ready to leave the hospital. Barely thirty years old, and she had just burned her last bridge and had nowhere to go. Well, for what it’s worth, I think it’s excellent. “No, I’m doing another one.

Psychiatric 97

Psychiatric Hospitals Wellness Military 97

EB Medicine

APRIL 30, 2017

In it, co-authors Emily Singer Fisher, MD, and Boyd Burns, DO, FACEP, FAAEM, both of the University of Oklahoma School of Community Medicine, cover evidence published in 190 articles, and 10 reviews from the Cochrane database, as well as current guidelines issued by the American Heart Association and the American College of Cardiology Foundation.

Outcomes 40

Outcomes Burns Best Practices Ultrasounds 40

Sensible Medicine

JUNE 21, 2024

“Well,” my friend advised, “if you’re feeling nervous right now, that is because the thing you are about to do might upset people, and that takes courage.” Cautious professionals, it turns out, try not to burn what they’ve built. It was the night before a health ethics conference at a university.

Academics 81

Academics Research Burns Outcomes 81

Taming the SRU

MAY 11, 2024

Of note, HTS is more effective in trauma patients because it is used as a resuscitative fluid as well. 3% HTS will lower ICP about 25-30% in about 15 minutes and does not appear to be more efficacious compared to mannitol. Should it be given in the prehospital setting?

Administration 91

Administration Resuscitation Fluid Resuscitation Research 91

Ziqitza HealthCare Ltd

JULY 19, 2023

In this blog, we will discuss indoor exercise routines for rainy days, outdoor activities and safety precautions, the importance of warm-up and stretching, cardiovascular and strength training exercises, and yoga and meditation for wellness with Ziqitza Health care limited. Set up a serene space in your home and follow online yoga classes.

Ambulance Services 52

Ambulance Services Wellness Burns 52

American Medical Compliance

JULY 31, 2023

Symptoms of Dysphagia Signs and symptoms associated with dysphagia can include: pain while swallowing, inability to swallow, drooling, hoarseness, regurgitation, weight loss, frequent heart burn, among others. Flexible Endoscopic Evaluation of Swallowing with Sensory Testing (FEESST) will be used initially by HCP.

Stroke 52

Stroke Burns Wellness 52

Mind The Bleep

AUGUST 18, 2024

They commonly present with a ‘flattened cheekbone’ and can involve orbital rim as well. Examination Use a systematic approach to ensure you do not miss any key areas. Below is one approach you can use; it lists common pathologies and deformities to look out for.

Fractures 91

Fractures Soft Tissue Injuries Burns Emergency Department 91