ACEP Now

JANUARY 4, 2025

The photos that Dr. Clarke took from 19781980 provide a glimpse into working in an emergency department in the years the specialty was being established. Medical anti-shock trousers (MAST) being applied for a trauma patient and a Datascope cardiac monitor in use during traumatic full arrest. Click to enlarge.) Click to enlarge.)

Forensics 52

Forensics Urgent Care Hospitals Emergency Department 52

Taming the SRU

JANUARY 10, 2024

89% agree that violence in the emergency department has harmed patient care. Scrutinize but don’t overthink (interpret your EKGs with context) Know your splints Be comfortable with OMI EKGs Know your resources & know when to ask for help Be creative

EKG/ECG 93

EKG/ECG Shock Fractures Dislocations 93

Dr. Smith's ECG Blog

AUGUST 9, 2024

Written by Colin Jenkins and Nhu-Nguyen Le with edits by Willy Frick and by Smith A 46-year-old male presented to the emergency department with 2 days of heavy substernal chest pain and nausea. These diagnoses were not found in his medical records nor even a baseline ECG. The patient continued having chest pain.

EKG/ECG 108

EKG/ECG EMS Emergency Department Wellness 108

EMDocs

OCTOBER 8, 2024

Glucose POC ECG: Is this actually sinus tachycardia? Looking at the initial or even repeating the ECG will be helpful here. Additional resuscitation Have we addressed all potential sources of shock for the patient in front of us? Does the patient require blood, a procedure to address obstructive shock, or other source control?

Shock 105

Shock Emergency Department Pediatrics EKG/ECG 105

Dr. Smith's ECG Blog

NOVEMBER 12, 2020

He had the following EKG recorded: Low voltage, suggests effusion. He underwent CPR, and regained a pulse after epinephrine, with an organized narrow complex rhythm at 140, but still with severe shock. Assessment was severe sudden cardiogenic shock. He remained hypotensive and in shock. He was moderately hypoxic.

Shock 52

Shock EKG/ECG Outcomes Hospitals 52

Dr. Smith's ECG Blog

OCTOBER 26, 2010

He presented to the Emergency Department with a blood pressure of 111/66 and a pulse of 117. He had this ECG recorded. He was rushed by residents into our critical care room with a diagnosis of STEMI, and they handed me this ECG: There is sinus tachycardia with ST elevation in II, III, and aVF, as well as V4-V6.

EKG/ECG 52

EKG/ECG Dehydration Fluid Resuscitation Sepsis 52

ACEP Now

JULY 7, 2023

emergency departments (EDs), with statistics reporting more than 356,000 out-of-hospital cardiac arrests per year. emergency departments (EDs), with statistics reporting more than 356,000 out-of-hospital cardiac arrests per year. 6 What Can I Do Outside of Repeated Shocks and Standard ACLS? Circulation.

Resuscitation 98

Resuscitation Shock Stroke Hospitals 98

EB Medicine

MARCH 1, 2019

This month, after a few months of primarily medical topics, we’re talking trauma, specifically Blunt Cardiac Injury: Emergency Department Diagnosis and Management. Consider valvular injury in any patient who appears to be in cardiogenic shock, has hypotension without obvious hemorrhage, or has pulmonary edema.

Emergency Department 40

Emergency Department EKG/ECG Operations Fractures 40

Dr. Smith's ECG Blog

JANUARY 9, 2024

She presented to the emergency department after a couple of days of chest discomfort. The ECG below was recorded. The ECG was interpreted as showing atrial flutter with 2:1 conduction. Answer : The ECG above shows a regular wide complex tachycardia. How do you interpret the below ECG? This is very prolonged.

EKG/ECG 120

EKG/ECG Stroke Hospitals Documentation/Coding 120

Dr. Smith's ECG Blog

JANUARY 15, 2024

Colin is an emergency medicine resident beginning his critical care fellowship in the summer with a strong interest in the role of ECG in critical care and OMI. A patient in their 40s with type 1 diabetes mellitus and hyperlipidemia presented to the emergency department with 5 days of “flu-like” illness.

EKG/ECG 65

EKG/ECG Point-of-Care Testing Wellness Shock 65

EB Medicine

NOVEMBER 1, 2018

But this month’s episode is special in its own way - we’ll be tackling Electrical Injuries in the emergency department - from low and high voltage injuries to the more extreme and rare lightning related injuries. Nachi: Each year, in the US, approximately 10,000 patients present with electrical burns or shocks. That’s -- high.

Emergency Department 40

Emergency Department Burns EKG/ECG Shock 40

EB Medicine

JANUARY 10, 2020

Show Notes Please click here and take our listener survey Emergency Department management of Non-St Segment Elevation Myocardial Infarction, by Drs Julianna Jung and Sharon Bord. MACE= Major Adverse Cardiovascular Event: including re-infarction, stroke, dysrhythmia, heart failure, cardiogenic shock, and death.

Emergency Department 40

Emergency Department Shock EKG/ECG Sepsis 40

The Skeptics' Guide to EM

SEPTEMBER 11, 2021

She arrives in the emergency department (ED) with decreased level of consciousness and shock. The EKG shows sinus tachycardia with nonspecific changes and no ST segment elevations, Q waves, or hyperacute T waves. Acute coronary syndrome (ACS) is responsible for the majority (60%) of all OHCAs in patients.

EKG/ECG 52

EKG/ECG Academics EMS CPR 52

EB Medicine

AUGUST 6, 2022

In this episode, Sam Ashoo, MD interviews Adam Sigal, MD and Stephanie Costa, MD - the authors of the August 2022 EMP article on Managing Acute Cardiac Valvular Emergencies in the Emergency Department. Listen to the discussion to hear more about the emergency medicine approach to valvular emergencies.

COPD 52

COPD Emergency Department Shock EKG/ECG 52

EB Medicine

DECEMBER 1, 2021

Table 3 ADD-RS score Exam Diagnostics Labs EKG – STEMI? Imaging CXR Echo CT MRI Aortogram Treatment BP management Heart Rate Shock Surgery – Who goes and when? It is in Beta and your feedback is welcome. Risk Factors Prehospital Care – what should EMS be looking for? ED Care History HTN, Pulse defecits, Chest Pain, Syncope?Table

EKG/ECG 52

EKG/ECG Emergency Department EMS Shock 52

Dr. Smith's ECG Blog

AUGUST 9, 2019

Some total LAD occlusion manifest on the ECG similarly to some left main occlusions. Depending on where the STE vector of the LM occlusion shows up on the ECG, there may be either STE, or STD, or neither in aVR, and lead aVR will not be the important part of the ECG interpretation in these cases.

EKG/ECG 52

EKG/ECG Shock Emergency Department Wellness 52

Dr. Smith's ECG Blog

JANUARY 23, 2023

Submitted and written by Megan Lieb, DO with edits by Bracey, Smith, Meyers, and Grauer A 50-ish year old man with ICD presented to the emergency department with substernal chest pain for 3 hours prior to arrival. The screening physician ordered an EKG and noted his ashen appearance and moderate distress. ng/mL (ULN 0.04).

EKG/ECG 52

EKG/ECG Shock Emergency Department Ultrasounds 52

Taming the SRU

SEPTEMBER 24, 2023

Statistically, 1/10 patients who present to the emergency department have hepatitis C, with an estimated 2.5-3.5 Diaz, Fabiano, And martella The presentation of adrenal crisis is often nonspecific, so it is important to keep a broad differential in cases of undifferentiated shock. and Kathleen Hildreth, Pharm.

Seizures 52

Seizures EKG/ECG Emergency Department Shock 52

PHEM Cast

APRIL 10, 2016

Think about ECG as an example, So, where the box is green, the test has given us the correct result for the patient. Am J Emerg Med. One year mortality of patients treated with an emergency department based early goal directed therapy protocol for severe sepsis and septic shock: a before and after study.

Sepsis 52

Sepsis Fluid Resuscitation Resuscitation Emergency Department 52

Dr. Smith's ECG Blog

JUNE 19, 2023

Written by Kaley El-Arab MD, edits by Pendell Meyers and Stephen Smith A 61-year-old male with hypertension and hyperlipidemia presented to the emergency department for chest tightness radiating to the back of his neck that has been intermittent for the past day or two. It is true this ECG does not meet STEMI criteria (there is 1.0

EKG/ECG 52

EKG/ECG Shock Emergency Department 52

Taming the SRU

JANUARY 26, 2024

Yates Case 1: Stroke and Stroke Mimics Early diagnosis of stroke improves stroke outcomes, where misdiagnosis is associated with an upwards of 4-time higher likelihood of mortality Missed strokes most often occur with atypical symptoms, in younger aged patients, those with posterior strokes, and those with lower NIH scores It can be difficult to discern (..)

Stroke 59

Stroke EKG/ECG Seizures Outcomes 59

Dr. Smith's ECG Blog

NOVEMBER 4, 2022

What is your ECG interpretation and what would you do next? This ECG shows a normal sinus rhythm with a normal conduction pattern (normal PR, normal QRS, and normal QTc), normal axis, late R wave progression (and misplaced V2), normal voltages, ST-elevation in aVR and global ST-depressions. BP was 110 and oxygen saturation was normal.

EKG/ECG 52

EKG/ECG Shock Sepsis Emergency Department 52

EB Medicine

JULY 8, 2019

This month, we are sticking in the abdomen for another round of evidence-based medicine, focusing on Emergency Department Management of Patients With Complications of Bariatric Surgery. Consider performing a RUSH exam (that is rapid ultrasound for shock and hypotension) to identify the cause.

Emergency Department 40

Emergency Department Sepsis Operations Dehydration 40

EM Curious

JULY 1, 2015

ECG PATTERN RECOGNITION CARDIAC ARREST AND ST ELEVATION: [BLOG]: Dr. Smith features a brief cardiac arrest case with an ECG pattern that you must know and be able to recognize! BONUS: User this article to identify what type of device your patient has if in the rare circumstance they don't know. Check out his post here.

EMS 52

EMS Ultrasounds EKG/ECG Fractures 52

The Skeptics' Guide to EM

SEPTEMBER 21, 2019

Case: A 55-year-old male presents to the emergency department with sudden onset of palpitations and pre-syncope starting one hour ago. His ECG shows atrial fibrillation with a rapid ventricular response. His ECG shows atrial fibrillation with a rapid ventricular response. Reference: Scheuermeyer et al.

Emergency Department 52

Emergency Department Stroke Academics Shock 52

ACEP Now

MARCH 14, 2024

A 44 year-old male with unknown past medical history came by emergency medical services (EMS) to the emergency department (ED) for an electrical injury and fall from a high voltage electrical pole. Electrical injuries—excluding lightning injuries—account for roughly 10,000 nonfatal shock incidents a year and 500 deaths a year.

Burns 52

Burns Fluid Resuscitation EKG/ECG EMS 52

EMDocs

APRIL 22, 2024

4 In an emergency department (ED) presentation of cardiac arrest, the diagnosis of PE is challenging without the use of CT angiography. Point-of-Care-Ultrasound (POCUS) is a bedside modality that can assist Emergency Physicians (EPs) in differentiating PE from other causes of cardiac arrest. EKG RV strain.

Ultrasounds 97

Ultrasounds Advances Cardiac Life Support (ACLS) EKG/ECG Resuscitation 97

Dr. Smith's ECG Blog

MAY 19, 2020

She was unable to be defibrillated but was cannulated and placed on ECMO in our Emergency Department (ECLS - extracorporeal life support). In this case, profound shock for 1 hour would result in the same degree of infarction. A followup ECG was recorded 2 days later: No definite evidence of infarction. Did YOU see them?

CPR 52

CPR EKG/ECG Shock Ultrasounds 52

Dr. Smith's ECG Blog

JULY 18, 2014

Here is his ECG: What is your interpretation? Case Continued 2 days later the patient became increasingly tachycardic, hypotensive, ashen, clammy (in cardiogenic shock) and had a new murmur. This was the 12-lead ECG. This remains consistent with PIRP, as was the first ECG. Ann Emerg Med 1994; 23(6):1333-42.

EKG/ECG 52

EKG/ECG Shock Ultrasounds Wellness 52

Northwestern EM Blog

JANUARY 24, 2022

Written by: Elizabeth Stulpin, MD (NUEM ‘23) Edited by: Aaron Wibberly, MD (NUEM ‘22) Expert Commentary by : Joshua Zimmerman, MD (NUEM ‘17) Non-Response to Vasopressors Shock is defined as a state of cellular and tissue hypoxia resulting in end organ dysfunction. And for most forms, EM physicians are not typically shocked by shock.

Anaphylaxis 52

Anaphylaxis Shock Sepsis Resuscitation 52

Dr. Smith's ECG Blog

JULY 7, 2013

Here is his ECG: There is atrial fibrillation at a rate of 95. Rupture can be either free wall rupture (causing tamonade) or septal rupture, causing ventricular septal defect with left to right flow and resulting pulmonary edema and shock. This was the 12-lead ECG. This remains consistent with PIRP, as was the first ECG.

Ultrasounds 52

Ultrasounds EKG/ECG Emergency Department Shock 52

Dr. Smith's ECG Blog

FEBRUARY 5, 2019

He had a triage ECG at time 0 (ECG-1): Computer read, with Physician overread: Sinus rhythm. If you see this, you must very closely question the patient about any chest symptoms, and even if no relevant symptoms, to be certain to look for old ECG, and to do serial ECGs and troponins. A 3rd ECG was recorded at 3.5

EKG/ECG 52

EKG/ECG Emergency Department Wellness Shock 52

Resus Review

AUGUST 27, 2015

She had just left the hospital, and had so many scheduled doctor’s appointments over the next several weeks that the last thing she wanted to do was going to the emergency department. The ECG shows a bradycardia at rate of approximately 36 bpm. There were things to do around the house…shopping, cleaning, mail.

Operations 52

Operations EKG/ECG Hospitals Emergency Department 52

The Skeptics' Guide to EM

JANUARY 7, 2023

Acute management of atrial fibrillation in congestive heart failure with reduced ejection fraction in the emergency department. Acute management of atrial fibrillation in congestive heart failure with reduced ejection fraction in the emergency department. Date: January 4th, 2023 Reference: Hasbrouck et al.

Emergency Department 40

Emergency Department Research Shock EKG/ECG 40

Taming the SRU

MAY 1, 2023

A retrospective evaluation of phenobarbital versus benzodiazepines for the treatment of alcohol withdrawal in a regional Canadian emergency department Link: [link] Bottom Line: This study in a small regional ED showed a QI project rolling out a Phenobarbital or Diazepam for Alchohol withdrawal syndrome. and NPV(50%).

Poisoning 52

Poisoning Hyperthermia / Hypothermia Seizures Emergency Department 52

Pediatric Emergency Playbook

DECEMBER 1, 2015

It’s a high-flow artery to the face, and if disrupted, the child may have significant bleeding and possibly hemorrhagic shock. Regardless of the exposure, obtain an ECG and look for bundle branch block, heart block, and dysrhythmias , since those will change disposition. J Emerg Med. Electrical Injuries: Shocking or Subtle?”

Burns 40

Burns EKG/ECG Emergency Department Shock 40

Taming the SRU

APRIL 13, 2023

stent, percutaneous nephrostomy) by urology or IR Hypokalemia evaluate for EKG changes assess for underlying cause and factors that may influence ability to replete (i.e. EtOH, amphetamines, or cocaine) Prescription drugs (i.e.

Hyperthermia / Hypothermia 52

Hyperthermia / Hypothermia Poisoning EKG/ECG Seizures 52