Dr. Smith's ECG Blog

JANUARY 2, 2025

By Smith with comments from our electrophysiologist, Rehan Karim. (And of course Ken's comments at the bottom) An elderly obese woman with cardiomyopathy, Left bundle branch block, and chronic hypercapnea presented hypoxic with altered mental status. She was intubated. Bedside cardiac ultrasound showed moderately decreased LV function. CT of the chest showed no pulmonary embolism but bibasilar infiltrates.

EKG/ECG 115

EKG/ECG Sepsis Wellness Documentation/Coding 115

Sensible Medicine

JANUARY 23, 2025

Two health obsessions that I’ve never really understood are the supposed benefits of vitamin D (for every imaginable ill) and harm of seed oils. Dr. Bobby Dubois thinks a lot about the evidence behind health recommendations on his podcast. His research has led him to a pretty clear opinion about the role of seed oils in health and disease. Attentive Sensible Medicine readers will note that his take is a bit different from that expressed in a recent post.

Wellness 111

Wellness Stroke Research 111

ACEP Now

JANUARY 5, 2025

Its 4 a.m., and youre three hours from the nearest tertiary care center. A young woman, 13 days post-tonsillectomy, comes into your rural emergency department (ED) coughing up blood. On exam, you see bright red blood trickling down her left tonsillar fossa. Her vital signs are normal, except for a heart rate of 115 bpm. Its going to take time to get her to a tertiary center.

Airway Management 98

Airway Management Operations Resuscitation Pediatrics 98

EM Ottawa

JANUARY 9, 2025

In the acute care setting, steroids have various usages and indications, but their usage can often be nuanced. From adrenal crises to septic shock, severe community-acquired pneumonia, and even acute pharyngitis, steroids play a pivotal role in managing a variety of conditions encountered in the Emergency Department (ED). However, their use is far from straightforwardbalancing […] The post These are the ‘Roids you are looking for – Steroids in the ED appeared first on EMOttawa

Shock 114

Shock Emergency Department Infectious Diseases Sepsis 114

Speaker: Simran Kaur, Co-founder & CEO at Tattva.Health

AI is transforming clinical trials—accelerating drug discovery, optimizing patient recruitment, and improving data analysis. But its impact goes far beyond research. As AI-driven innovation reshapes the clinical trial process, it’s also influencing broader healthcare trends, from personalized medicine to patient outcomes. Join this new webinar featuring Simran Kaur for an insightful discussion on what all of this means for the future of healthcare!

Outcomes

EMDocs

JANUARY 11, 2025

Author: Christopher Blanton, MD, MBA (EM Resident, UTSW / Dallas, TX); Joslin Gilley-Avramis, MD (EM Attending Physician, UTSW / Parkland Memorial Hospital) // Reviewed by: Sophia Grgens, MD (EM Physician, BIDMC, MA); Cassandra Mackey, MD (Assistant Professor of Emergency Medicine, UMass Chan Medical School); Brit Long, MD (@long_brit) Welcome to EM@3AM, an emDOCs series designed to foster your working knowledge by providing an expedited review of clinical basics.

EMS 97

EMS Sepsis Shock Fluid Resuscitation 97

Emergency Medicine Journal

JANUARY 21, 2025

Trauma remains a significant cause of mortality and morbidity. Non-compressible torso haemorrhage is one of the key drives of these mortality data. Our contemporary management has focused on damage control resuscitation, with a focus on haemorrhage control, haemostatic resuscitation and permissive hypotension. The evidence for permissive hypotension lacks the robustness as other treatments, such as tranexamic acid.

Resuscitation 91

Resuscitation 91

St. Emlyn

JANUARY 6, 2025

St.Emlyn's - Emergency Medicine #FOAMed How does pre-hospital emergency anaesthesia (PHEA) delivered by Helicopter Emergency Medical Services (HEMS) impacts trauma care timelines compared to emergency department RSI (EDRSI). This retrospective study explores time efficiency, injury severity, and patient outcomes, highlighting the role of HEMS in delivering critical care to severely injured patients in remote locations.

Emergency Department 98

Emergency Department Outcomes Hospitals 98

Sensible Medicine

JANUARY 30, 2025

A limited mask mandate is returning to my state this week. In 2023, the Maryland Department of Health (DOH) adopted a standard for return to universal masking in healthcare facilities when hospitalizations with respiratory viruses (covid, influenza, or RSV) reach a level of 10 cases per 100,000 population. Maryland has a population of 6.3 million and about 10,000 licensed hospital beds, so that works out to about 6% of hospital beds.

CDC 102

CDC Hospitals Academics 102

ECG Guru

JANUARY 30, 2025

In this 12-lead ECG there is a bradycardic rhythm, which is regular, heart rate about 45 bpm. The QRS complexes are narow. What is this rhythm called? There are no P waves present, and no flutter or fibrillation waves can be seen. There are 2 possibilities: 1. There is a sinus arrest with a junctional escape rhythm. The junctional rhythm either cannot conduct retrograde to the atria (therefore no inverted retrograde P wave can be seen) or the retrograde P wave is hidden in the QRS complex (atria

EKG/ECG 101

EKG/ECG 101

EB Medicine

JANUARY 7, 2025

In this episode, Sam Ashoo, MD interviews Nicholas Stark, MD, MBA & Zaid Altawil, MD about the Emergency Medicine Innovation Collaborative 1. Discussion on EMIC - Overview of the collaborative - Background and formation during the pandemic in late 2021 2. Growth of EMIC - Expansion from three members to over 500 - Focus areas: Education, mentorship, opportunity 3.

EMS 83

EMS 83

Emergency Medicine Journal

JANUARY 21, 2025

This month’s update is by the Emergency Department of the University Hospital of Heraklion, Crete, Greece. We used a multimodal search strategy, drawing on free open-access medical education resources and literature searches. We identified the five most interesting and relevant papers (decided by consensus) and highlighted each paper’s main findings, key limitations and clinical bottom line.

Emergency Department 98

Emergency Department Hospitals Outcomes 98

Emergency Medicine Cases

JANUARY 28, 2025

On this month's EM Quick Hits podcast: Anand Swaminathan on optimizing RSI medication timing, Brittany Ellison ED boarding challenges in older patients and solutions to ED crowding and flow, Dave Jeromeon managing prolonged tourniquet application, Nour Khatib and Phil Gillick on a rural peer support case, Jesse McLaren on ECG reciprocal changes in acute coronary occlusion, and Melody Ngon practical nutrition tips for shift workers.

EMS 97

EMS EKG/ECG Resuscitation 97

St. Emlyn

JANUARY 7, 2025

St.Emlyn's - Emergency Medicine #FOAMed Mastering likelihood ratios can transform your diagnostic skills. In this podcast with Rick and Greg, discover how likelihood ratios can enhance decision-making and improve patient care. The post Podcast – Likelihood Ratios: Critical Appraisal Nugget 12 appeared first on St.Emlyn's.

Research 114

Research 114

EMDocs

JANUARY 25, 2025

Authors: Michael Sperandeo, MD (Assistant Professor, Dept of Emergency Medicine, Long Island Jewish Medical Center, Associate Program Director EMSL Medical Simulation Fellowship, Zucker School of Medicine at Hofstra/Northwell); Sophia Grgens, MD (EM Physician, BIDMC, MA) // Reviewed by: Cassandra Mackey, MD (Assistant Professor of Emergency Medicine, UMass Chan Medical School); Brit Long, MD (@long_brit); Alex Koyfman, MD (@EMHighAK) Welcome to EM@3AM, an emDOCs series designed to foster your wo

EMS 94

EMS Infectious Diseases Allergic Reactions Fluid Resuscitation 94

The Bottom Line

JANUARY 30, 2025

Antibiotic Treatment for 7 versus 14 Days in Patients with Bloodstream Infections BALANCE Investigators. NEJM 2024; DOI: 10.1056/NEJMoa2404991 Clinical Question In hospitalised patients with bloodstream infections (BSI), is antibiotic treatment for 7 days, compared to treatment for 14 days, non-inferior with respect to mortality at 90 days?

95

95

EB Medicine

JANUARY 25, 2025

In this episode, Sam Ashoo, MD and T.R. Eckler, MD discuss the January 2025 Emergency Medicine Practice article, Alkali Exposure: An Evidence-Based Approach to Diagnosis and Treatment Patient Demographics and Case Scenarios: Types of patients prone to alkali exposure Causes and scenarios leading to alkali exposure (e.g., accidental, intentional, social media challenges) Poison control reports and statistics Types and Effects of Exposure: Different types of exposure: ingestion, ocular, dermal Eff

Poisoning 80

Poisoning EKG/ECG Airway Management Resuscitation 80

EM Literature of Note

JANUARY 16, 2025

This little article has made the rounds, primarily by those who critique it for its many flaws. However, the underlying themes can still be valid, even if an article has limitations. This is a “there is variation in emergency physician admitting practices” article. Literally every practicing physician working in a hospital environment knows there is a broad spectrum of skill, approach to acute illness, and level of risk-tolerance.

Outcomes 77

Outcomes Radiology Radiology Emergency Department 77

ALiEM

JANUARY 13, 2025

A 55-year-old female presented with the complaint of my right eye popped out. Symptoms started approximately seven hours prior to arrival and progressive, severe pain eventually prompted her visit to the ED. This happened once 10 years ago, requiring reduction in the ED. The patient denied preceding trauma, rubbing her eyes/eye-lids, or any history of thyroid disease.

Academics 67

Academics Emergency Department 67

St. Emlyn

JANUARY 6, 2025

St.Emlyn's - Emergency Medicine #FOAMed How does pre-hospital emergency anaesthesia (PHEA) delivered by Helicopter Emergency Medical Services (HEMS) impacts trauma care timelines compared to emergency department RSI (EDRSI). The post Prehospital Emergency Anaesthesia (PHEA) vs. Emergency Department RSI: A Comparative Study on Trauma Care Timelines and Outcomes appeared first on St.Emlyn's.

Emergency Department 99

Emergency Department Outcomes Hospitals 99

EMDocs

JANUARY 1, 2025

Authors:Brit Long, MD ( @long_brit EM Attending Physician, San Antonio, TX);Manpreet Singh, MD ( @MPrizzleER Assistant Professor of Emergency Medicine / Department of Emergency Medicine Harbor-UCLA Medical Center); andAlex Koyfman, MD ( @EMHighAK EM Attending Physician, UT Southwestern Medical Center / Parkland Memorial Hospital) Happy New Year, and thank you for everything you do!

Sepsis 75

Sepsis EMS EKG/ECG Hospitals 75

Emergency Medicine Journal

JANUARY 21, 2025

A short systematic review was undertaken to assess whether intradermal sterile water injections (ISWI) provide effective pain relief in adult patients presenting to the Emergency Department (ED) with renal colic. MEDLINE, Embase, Cochrane and Google Scholar databases were searched, identifying seven relevant studies. Study information, patient characteristics, key results and methodological weaknesses were tabulated.

Emergency Department 52

Emergency Department Research 52

The Evolution & Medicine Review

JANUARY 28, 2025

Oxygen is essential for human life, yet a growing body of preclinical research is demonstrating that chronic continuous hypoxia can be beneficial in models of mitochondrial disease, autoimmunity, ischemia, and aging. This research is revealing exciting new and unexpected facets of oxygen biology, but translating these findings to patients poses major challenges, because hypoxia can be dangerous.

Research 52

Research 52

PEMBlog

JANUARY 21, 2025

The concurrent circulation of influenza, respiratory syncytial virus (RSV), COVID-19, and norovirus during peak viral seasons presents a diagnostic challenge in pediatric emergency settings. Differentiating these pathogens based on clinical presentation is crucial for targeted management, minimizing unnecessary diagnostic tests, and optimizing healthcare resources.

Rapid Diagnostic Testing 52

Rapid Diagnostic Testing Pediatrics Dehydration Outcomes 52

ACEP Now

JANUARY 4, 2025

Emergency medicine was approved as the 23rd medical specialty in 1979, shortly after a young Elsburgh Clarke, MD, discovered the burgeoning specialty. 1 Just one year prior, Dr. Clarke had begun an emergency medicine residency at what was then known as LA CountyUSC Hospital, Los Angeles. I was about two months into a family practice internship when I went to visit my uncle whose neighbor happened to be an ED resident, Dr.

Forensics 52

Forensics Urgent Care Hospitals Emergency Department 52

St. Emlyn

JANUARY 14, 2025

St.Emlyn's - Emergency Medicine #FOAMed The monthly update podcast from November 2024, including learning culture, chest drains in haemothorax, arterial lines in cardiac arrest and bad behaviour. The post Podcast – Monthly Round Up November 2024 – Learning culture, chest drains, arterial lines and more appeared first on St.Emlyn's.

Resuscitation 97

Resuscitation 97

Emergency Medicine Cases

JANUARY 28, 2025

Discover how Global EM principles can be applied to rural medicine in North America. Dr. Arjun Sithamparapillai challenges misconceptions about Global Health sustainability, and highlights the critical role of teamwork, adaptability, and equity in underserved communities. Perfect for EM professionals balancing family, career, and a passion for global impact.

Teamwork 54

Teamwork EMS 54

Emergency Medicine Journal

JANUARY 21, 2025

Background Growing numbers of avoidable low-acuity visits to emergency departments (ED) are a major health policy concern globally and are thought to contribute to ED crowding. This study explores the differences in the utilisation of low-acuity ED visits between culturally and linguistically diverse (CaLD) migrants and English-speaking background (ESB) population.

Emergency Department 52

Emergency Department 52

Northwestern EM Blog

JANUARY 7, 2025

Written by: Ashley Segobiano, MD (NUEM 28). Edited by: Nicholas Maurer, MD, MPH (NUEM 26). Expert Review by : Molly Estes, MD Molly Estes, MD Emergency Medicine Physician, Assistant Professor at Feinberg School of Medicine Northwestern Memorial Hospital, Feinberg School of Medicine How To Cite This Post: [Peer-Reviewed, Web Publication] Segobiano, A.

Hospitals 59

Hospitals 59

PulmCCM

JANUARY 6, 2025

In the past decade, so-called “sepsis alerts” came out of nowhere to become a ubiquitous and resource-intensive component of inpatient medical care. The trouble is, no one checked first to see if they work. “Sepsis alerts” are automated notifications that flag patients who meet certain criteria compatible with severe infection discernible from the electronic medical record.

Sepsis 45

Sepsis Documentation/Coding Hospitals Outcomes 45

The Skeptics' Guide to EM

JANUARY 25, 2025

Date: January 9, 2025 Reference: White et al. Evidence of questionable research practices in clinical prediction models. BMC Med 2023 Guest Skeptic: Dr. Jestin Carlson is the Program Director for the AHN-Saint Vincent EM Residency in Erie Pennsylvania. He is the former National Director of Clinical Education for US Acute Care Solutions and an American Red Cross Scientific Advisory Council member.

Research 49

Research EMS Documentation/Coding Operations 49

St. Emlyn

JANUARY 13, 2025

St.Emlyn's - Emergency Medicine #FOAMed Explore the variability in maintaining prehospital anaesthesia for trauma patients in this comprehensive summary of a multinational survey. With insights into drug protocols, administration methods, and governance, the article highlights challenges and opportunities for standardisation in prehospital care.

Administration 59

Administration Research Outcomes 59

Dr. Smith's ECG Blog

JANUARY 7, 2025

(This was created by Arron Pearce ( [link] ) Online QT calculator for wide QRS (LBBB, RBBB, etc.

111

111

Emergency Medicine Journal

JANUARY 21, 2025

Background Evidence regarding high-dose inhaled corticosteroids (HDICS) in asthma exacerbations in adults is insufficient. 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

The Bottom Line

JANUARY 16, 2025

Whats new in the Critical Care literature monthly updates

109

109

PulmCCM

JANUARY 23, 2025

Various new “sepsis tests” have come to market or will soon, claiming to solve the problem of diagnostic imprecision in the early management of suspected sepsis. Could they? The lack of a reliable diagnostic test or universally accepted criteria to diagnose sepsis leads to significant challenges in clinical practice and research. Overly general case definitions and sloppy EMR algorithms result in a high rate of overtreatment with antibiotics due to false positives, as well as delayed

Sepsis 45

Sepsis Wellness Emergency Department Research 45

RebelEM

JANUARY 21, 2025

Background: The current standard care for evaluating pulmonary embolism (PE) advises against D-dimer testing in patients with a high clinical probability. European and American guidelines emphasize a sequential diagnostic approach based on pretest probability assessment using either a formal clinical decision instrument (e.g., Wells’ , Revised Geneva ) or clinical gestalt.

EMS 45

EMS Research Wellness Outcomes 45