EM SIM Cases

NOVEMBER 15, 2022

He previously served as Deputy Medical Director at Andersen Simulation Center, the largest simulation center in the US Army as well as the Simulation Director for Madigan Army Medical Center’s Department of Emergency Medicine Residency. His initial presentation will respond to traditional therapies for COPD exacerbation.

COPD 52

COPD Military Emergency Department EMS 52

Dr. Smith's ECG Blog

DECEMBER 13, 2023

And she learned it well: She is not highly confident, but she does diagnose OMI. Figure-1: I've labeled the initial ECG in today's case — as well as enlarging the QRST complex in lead V2. The differential diagnosis for "low voltage" that is frequently put forth by many providers is often limited to COPD and/or pericardial effusion.

EKG/ECG 120

EKG/ECG COPD Wellness Outcomes 120

RebelEM

JANUARY 25, 2024

It can be used to distinguish between various conditions, including chronic obstructive pulmonary disease (COPD) exacerbation, acute heart failure (AHF), pleural effusion, pulmonary edema, pericardial effusion, pneumothorax, and pneumonia [2,3]. to −0.66) and −1.66 (95% CI −2.09 to −0.78) and -1.97 (95% CI −2.70 vs. 18.3%).

Ultrasounds 128

Ultrasounds Outcomes COPD Hospitals 128

PulmCCM

SEPTEMBER 21, 2024

Non-invasive positive pressure ventilation (NPPV) has a well-established role in the treatment of acute exacerbations of chronic obstructive pulmonary disease (AECOPD) with hypercarbia.

COPD 40

COPD Wellness 40

Taming the SRU

OCTOBER 28, 2024

Most common triggers include respiratory conditions such as asthma, COPD, and pneumonia which can lead to forceful coughing -Other common triggers include forceful exertion, severe coughing or vomiting, asthma exacerbation, intense physical activity, or Valsalva maneuvers (e.g., weightlifting, childbirth) [4].

COPD 78

COPD Pediatrics Emergency Department Ultrasounds 78

Sensible Medicine

AUGUST 21, 2023

This is a common probably insurmountable problem with morbidities, such as hypertension, diabetes , COPD , etc. The arguments advanced in favor of forthrightness in articulating the purposes of epidemiological studies, and the need for rigor and transparency in their methods are extremely well supported. It is our goal.

Administration 85

Administration Outcomes Research COPD 85

RebelEM

AUGUST 21, 2023

It’s important to be able to initiate these treatments while also creating the opportunity to investigate possible therapeutic interventions for these patients within the confines of a well designed trial.

Hospitals 98

Hospitals Resuscitation Outcomes CPR 98

Ziqitza HealthCare Ltd

JANUARY 1, 2024

This is particularly concerning for those already grappling with conditions such as asthma or chronic obstructive pulmonary disease (COPD). Ziqitza Rajasthan emphasizes the need for awareness and education, offering resources to help individuals recognize and mitigate the impact of winter allergens on their respiratory well-being.

Ambulance Services 52

Ambulance Services COPD Leadership Wellness 52

Dr. Smith's ECG Blog

OCTOBER 12, 2024

A man in his 90s with a history of HTN, CKD, COPD, and OSA presented to the emergency department after being found unresponsive at home. The providers documented concern for ST elevation in the precordial and lateral leads as well as a concern for hyperkalemic T waves in the setting of succinylcholine administration.

EKG/ECG 105

EKG/ECG Documentation/Coding Emergency Department COPD 105

Sensible Medicine

JUNE 30, 2023

On the other hand, KW was a middle-aged American man with chest pain and significant risk factors for coronary artery disease – hypertension and diabetes – neither of which had ever been terribly well-controlled. She was well hydrated and her vital signs were normal. He had COPD and depended on home oxygen.

Hospitals 89

Hospitals Hospice Resuscitation COPD 89

PulmCCM

MARCH 25, 2024

In a well-randomized trial, equal numbers of clinically important differences in outcomes in opposite directions could average out to a null result, hiding the variability between patients. Those trials could well suggest entirely different sets of variables that might interact to produce heterogeneity of treatment effects for oxygen.

COPD 52

COPD Outcomes Research Wellness 52

Dr. Smith's ECG Blog

NOVEMBER 25, 2017

Written by Pendell Meyers, edits by Smith: Case A 72 year old female with hypertension and COPD presented with sudden shortness of breath and chest pain. More important, there is right bundle branch block with hyperacute concordant T-waves in V3-V6, as well as hyperacute T-waves in leads III and aVF with reciprocal ST depression in aVL.

COPD 52

COPD EKG/ECG Wellness Outcomes 52

Dr. Smith's ECG Blog

SEPTEMBER 17, 2023

There is some upwards concave ST segment elevation in the inferior leads with what seems to be well formed J-waves. maybe not seen well on these echo-loops) The CW doppler at the tricuspid valve showed a maximum TR velocity of 2,55m/s with a TRP gradient of 26mmHg. Not much difference from 1st ECG. A bedside echo was performed.

EKG/ECG 103

EKG/ECG COPD Wellness Shock 103

ACEP Now

DECEMBER 6, 2024

A 45-year-old male with a history of chronic obstructive pulmonary disease (COPD), asthma, amphetamine and tetrahydrocannabinol (THC) use, and coronary vasospasm presented to triage with chest pain. Cardiac arrest secondary to myocardial ischemia from coronary vasospasm is well documented.

Resuscitation 52

Resuscitation EKG/ECG Documentation/Coding COPD 52

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. There are many different types of pneumothorax (PTX), and the management paradigm has shifted in recent years as the research has exploded on this topic.

Fractures 96

Fractures COPD Hospitals Emergency Department 96

Emergency Medicine Ireland

MARCH 27, 2023

Now this is not the post to explore it, but perhaps suffice to say that someone sitting with a resp rate of 30 for a week on 80% O2 and a PEEP of 10 on NIV may well be undergoing some of the same lung stress that any typical ventilated ARDS patient may be undergoing. NIV is not necessarily a free pass. NIV is not necessarily a free pass.

COPD 52

COPD Wellness Fractures Hospitals 52

Taming the SRU

NOVEMBER 6, 2024

jarrell, leenellett and lafollette Our workforce is changing and our interactions with our colleagues are changing as well. Leadership curriculum - Airway academy - R1 Core Content - R3 Small Groups leadership curriculum WITH drs. We will review how you may view differences in gender and generation to lead effectively.

Leadership 52

Leadership Dislocations Fractures COPD 52

Sensible Medicine

MARCH 11, 2024

Back to the Trial With proper randomization, the two groups should be well balanced with regard to baseline characteristics and therefore have no notable sources of bias and confounding. If this is the case then there can be only three possible explanations for the observed difference between the groups.

Outcomes 104

Outcomes Research Stroke COPD 104

Emergency Medicine Ireland

APRIL 26, 2021

Lung transplants do reasonably well overall (most likely due to careful selection) with a median survival of 7 years and 80% alive at one year. Oh’s Manual chapter 104 has a decent chapter on the intensive care aspects of lung transplant.

COPD 40

COPD Operations Wellness 40

RebelEM

NOVEMBER 16, 2022

Methemoglobinemia Pathoophysiology Mechanism of Action Pathophysiology Oxidized iron sites on MetHb unable to bind oxygen Remaining binding sites with increased affinity for binding oxygen Causes a leftward shift in the oxyhemoglobin dissociation curve Results in decreased tissue oxygen delivery Normal situation Red cells constantly exposed to oxidant (..)

Seizures 52

Seizures Administration Airway Management COPD 52

Dr. Smith's ECG Blog

JANUARY 5, 2020

This 60-something with h/o COPD and HFrEF (EF 25%) presented with SOB and chest pain. M Y A NSWER: In my opinion — it is both academic and clinically unimportant ( as well as often impossible ) to attempt to distinguish between sinus rhythm with multiple different-looking PACs vs MAT. Here is the ECG: What do you think? Poon et al.

EKG/ECG 52

EKG/ECG COPD Wellness Sepsis 52

PulmCCM

JUNE 10, 2024

3 days for anoxic encephalopathy to regain pupillary responses after cardiac arrest, 4-7 days for a DNR/DNI patient to receive NIPPV for COPD exacerbation, etc.) But there’s no alarm that beeps when well-intentioned care with an indeterminate prognosis crosses into something else, something darker. 2007 Dec 1;335(7630):1132.

COPD 45

COPD Outcomes Hospitals EMS 45

Dr. Smith's ECG Blog

FEBRUARY 28, 2020

This clinical information followed: "The patient had a COPD exacerbation with a prehospital SpO2 of 60%. Many patients with acute COPD exacerbations present with a similar heart rate. This is NOT Wellens. Is the patient hypoxic? The answer was yes. He had respiratory failure, was intubated, and was diagnosed with pneumonia."

EKG/ECG 52

EKG/ECG COPD Documentation/Coding Shock 52

Sensible Medicine

MAY 26, 2023

Atrial fibrillation, COPD, serous otitis media, pyelonephritis, a sprained knee, a rash, epididymitis, (I could go on and on and on) are all within your purview. All that said, primary care physicians are well compensated. You can answer any patient’s concerns. You are expected to do it all. The medicine is amazing.

COPD 49

COPD Wellness Outcomes Administration 49

Emergency Medicine Ireland

JANUARY 8, 2024

If you’re lungs don’t work so well then the device can replace a lot of their function in the short term. If the lungs aren’t working well then we need to capture at least 60% or so of this venous return and stick it through the oxygenator in order to maintain tolerable saturation of haemoglobin with oxygen.

Wellness 52

Wellness COPD 52

Emergency Medicine Ireland

JANUARY 10, 2022

The IBCC covers aspergillosis very well, and if this podcast does no more than refer you to the IBCC then my work is done. Josh makes an excellent point of pointing out that there is probably a different clinical pattern in the neutropaenic vs the non neutropaenic patient. COVID-19 as a risk factor is almost certainly a risk factor.

COPD 40

COPD Sepsis Wellness 40

Mind The Bleep

NOVEMBER 21, 2023

” Yes, I have seen clerking look like this and I can confirm, it does not go down well. Examples of examination findings you might find helpful to keep in mind (list not exhaustive): GCS 15/15- alert, orientated, looks comfortable, warm and well perfused, in obvious pain, looks pale and clammy etc.

Documentation/Coding 52

Documentation/Coding COPD EKG/ECG Wellness 52

EMDocs

APRIL 22, 2024

RV chamber size alone is not enough information to rule-in a PE as RV cavity enlargement can be visualized in other conditions such as pulmonary hypertension, RV infarct, COPD and cardiac arrest from multiple causes. If RV pressure is extreme, it can exceed LV pressure causing paradoxical septal wall motion toward the LV as well.

Ultrasounds 82

Ultrasounds Advances Cardiac Life Support (ACLS) EKG/ECG Resuscitation 82

Dr. Smith's ECG Blog

MARCH 12, 2018

This includes, but is not limited to, PE, asthma/COPD exacerbation, hypoxic vasoconstriction from pneumonia, acute pulmonary hypertension exacerbation. She was discharged and did well. This ECG is diagnostic of hemodynamically significant acute right heart strain. ST and T-wave abnormalities evolving appropriately.

EKG/ECG 40

EKG/ECG Radiology Radiology COPD 40

Dr. Smith's ECG Blog

NOVEMBER 28, 2022

There appears to be some ST elevation in leads II and aVF, as well as to a lesser extent in the lateral chest leads. Conduction and refractoriness alternans may be seen with WPW-related as well as AV Nodal-dependent reentr y tachycardias — atrial fibrillation — acute pulmonary embolus — myocardial contusion — and severe LV dysfunction.

EKG/ECG 40

EKG/ECG Ultrasounds Documentation/Coding COPD 40

Dr. Smith's ECG Blog

NOVEMBER 19, 2016

It was edited by Smith CASE : A 52-year-old male with a past medical history of hypertension and COPD summoned EMS with complaints of chest pain, weakness and nausea. This was contributed by some folks at Wake Forest: Jason Stopyra, Shannon Mumma, Sean O'Rourke, and Brian Hiestand. I would immediately intubate a patient who is this ill.

EKG/ECG 40

EKG/ECG Shock Fluid Resuscitation Documentation/Coding 40

EB Medicine

OCTOBER 1, 2018

Jeff : So as well all know Sepsis is bread and butter emergency medicine, but, what is sepsis? Sepsis is coming in at a higher readmission rate and cost per admission than acute MI, CHF, COPD, and PNA. If it’s possible to establish an IV and initiate fluids without delaying transport, EMS should do that as well.

Sepsis 40

Sepsis Shock Fluid Resuscitation Hospitals 40

EMDocs

FEBRUARY 12, 2024

Louis); Marina Boushra, MD (EM-CCM, Cleveland Clinic Foundation); Brit Long, MD (@long_brit) Case Emergency Medical Services brings in a 62-year-old male with COPD in acute on chronic hypoxemic respiratory failure (usually on 3 L nasal cannula, now on non-rebreather at 15 L/min). proning patients, ECMO) (12).

Emergency Department 94

Emergency Department Resuscitation COPD Shock 94

ACEP Now

JUNE 14, 2024

Chronic obstructive pulmonary disease (COPD) is a chronic disease of the lungs caused by inflammatory and structural changes of the small airways and parenchyma of the lungs that result in chronic airflow obstruction and gas trapping. In 2019, the global prevalence of COPD was estimated to be 10.3 Click to enlarge.

COPD 52

COPD Hospitals Emergency Department Outcomes 52

Sensible Medicine

SEPTEMBER 22, 2024

In studies, and in practice, these people tend to be patients with COPD who have resting O 2 sats of < 88%. The enrolled patients were not well. About 80% had either COPD or pulmonary fibrosis and the mean PaO 2 and O 2 sats were about 50mm Hg and 80%, respectively. What we have not really known is how much oxygen is enough.

COPD 97

COPD Outcomes Hospitals Shock 97

PulmCCM

OCTOBER 23, 2023

Even people with COPD or asthma under age 50 did not benefit from Paxlovid, in that analysis. Another observational cohort showed no reduction in hospitalization associated with Paxlovid use among vaccinated patients contracting Covid-19 in the Omicron era , except for the immunocompromised or high-risk patients over age 70.

Hospitals 98

Hospitals COPD Emergency Department CDC 98

RebelEM

MAY 15, 2024

The loss of these cells leads to immunosuppression as well as decreased responsiveness of the immune system as a whole Patients with neutropenia will not only get very sick very quickly, but also will have blunted immune response and may not localize signs of infection well Fever or malaise may be their only presenting symptoms.

Infectious Diseases 103

Infectious Diseases Administration Sepsis Anaphylaxis 103