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. for a few years working as an emergency physician. Dr. Clarke was then hired as assistant director in the emergency department (ED) at Pomona Valley Hospital, Pomona, Calif.

Forensics 52

Forensics Urgent Care Hospitals Emergency Department 52

ACEP Now

DECEMBER 7, 2024

A submassive PE does not result in hypotension but does result in right ventricular (RV) dysfunction (as evidenced by CT or ECG) and/or signs of myocardial injury, such as elevated B-type natriuretic peptide, elevated troponin, or new ECG changes. 6 The second common catheter-directed approach is mechanical thrombectomy.

Ultrasounds 52

Ultrasounds Radiology Radiology EKG/ECG 52

Dr. Smith's ECG Blog

NOVEMBER 30, 2022

This case was provided by Spencer Schwartz, an outstanding paramedic at Hennepin EMS who is on Hennepin EMS's specialized "P3" team, a team that receives extra training in advanced procedures such as RSI, thoracostomy, vasopressors, and prehospital ultrasound. Our first 12 lead ECG was then recorded at 0926. What do you think?

EKG/ECG 52

EKG/ECG Emergency Department Ultrasounds Hospitals 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

The Skeptics' Guide to EM

SEPTEMBER 28, 2024

Annals of Emergency Medicine, May 2024 Guest Skeptic: Dr. Casey Parker is a Rural Generalist from Australia who is also an ultrasounder. There are no abnormalities in the blood work, ECG, or chest x-ray. Diagnostic Accuracy of D-Dimer for Acute Aortic Syndromes: Systematic Review and Meta-Analysis.

Emergency Department 92

Emergency Department EKG/ECG Ultrasounds 92

Dr. Smith's ECG Blog

OCTOBER 2, 2021

Triage EKG: What do you think? A prior ECG was available for comparison. Prior EKG from 2 months ago was available: Let's put the precordial leads from the 2 ECGs side by side: Now you can really see the difference. Immediately after the second ECG was performed, the patient's pain resolved completely.

EKG/ECG 52

EKG/ECG Ultrasounds EMS Documentation/Coding 52

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. Jeff: And it likely goes without saying, but an EKG is a must on all trauma patients with suspicion for blunt cardiac injury in accordance with the EAST guidelines.

Emergency Department 40

Emergency Department EKG/ECG Operations Fractures 40

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

Broome Docs

MARCH 28, 2024

If you want to see Justin in the video format and his new Youtube series then click here: [link] If you would like to check out my current ultrasound training project then click here: WACHS Ultrasound Otherwise – enjoy the show and see you in a few weeks. Am J Emerg Med. 2022 Feb;52:85-91. doi: 10.1016/j.ajem.2021.11.030.

PPE 96

PPE Ultrasounds Resuscitation Emergency Department 96

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 Wellness Point-of-Care Testing Shock 65

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

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 Shock 97

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. Jeff: Let’s move on to evaluation in the emergency department. Jeff: You’re right. Let’s move on to treatment.

Emergency Department 40

Emergency Department Burns EKG/ECG Shock 40

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. Unanticipated death after discharge home from the emergency department. Ann Emerg Med. Qualitative factors in patients who die shortly after emergency department discharge.

Shock 105

Shock Emergency Department Pediatrics EKG/ECG 105

EM Curious

JULY 8, 2015

ULTRASOUND GOODIE BAG ULTRASOUND FOR LATE PREGNANCY [PODCAST]: While not a routine exam we perform other than confirming fetal heart tones, definitely some great pearls on more advanced US topic. Consider an ultrasound guided ulnar nerve block. Part 1 here. US GUIDED ULNAR NERVE BLOCK [BLOG]: Boxer's fracture need a reduction?

Infectious Diseases 52

Infectious Diseases Disaster Management Sepsis Ultrasounds 52

ACEP Now

JUNE 6, 2023

ECG, CXR, and troponin are negative. A medical student reports a murmur, not documented by either the emergency physician or the cardiologist. Troponins #1 and #2 are borderline and ECG is non-specific. In the ED, his troponin, ECG, and chest X-ray (CXR) are normal. ECG, CXR, and troponin are all normal.

EKG/ECG 85

EKG/ECG Stroke Documentation/Coding Operations 85

Taming the SRU

AUGUST 4, 2024

to teach you and your learner something new on shift skin adhesives WITH dr. hill Dermabond is a polymer (octyl cyanoacrylate) that can be used to repair lacerations in the Emergency Department faster than sutures, allowing the ED physician to be more efficient.

Dislocations 85

Dislocations Emergency Department Documentation/Coding Burns 85

ACEP Now

OCTOBER 9, 2024

In the emergency department (ED), physicians face the challenge of making rapid decisions that can significantly impact patient outcomes. Collaborating with one of my ultrasound faculty, we conducted a bedside echocardiogram to explore potential cardiac anomalies. Our workup started with an ultrasound and EKG.

EKG/ECG 52

EKG/ECG Fluid Resuscitation Ultrasounds Burns 52

EM Curious

JULY 1, 2015

ULTRASOUND IN CHEST PAIN: [BLOG]: It is never a bad idea to throw an ultrasound probe on your patient with chest pain. 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! Check out his post here.

EMS 52

EMS Ultrasounds EKG/ECG Fractures 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. Jeff: Next up is ultrasound.

Emergency Department 40

Emergency Department Sepsis Operations Dehydration 40

Dr. Smith's ECG Blog

MARCH 6, 2023

If you saw this ECG only knowing that it is an acute chest pain patient, what would be your interpretation? But you can make a diagnosis here, and Pendell and I do this all the time when reading ECGs from databases. The patient had this ECG recorded at 7 minutes after registration at triage as a walk-in (not by EMS): What do you think?

EKG/ECG 52

EKG/ECG Emergency Department Ultrasounds EMS 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. Epub 2021 Nov 15.

EKG/ECG 52

EKG/ECG Shock Emergency Department Ultrasounds 52

EMDocs

MAY 11, 2024

Semin Ultrasound CT MR. 2013 Apr;34(2):131-41. Available from: [link] American College of Emergency Physicians Clinical Policies Subcommittee (Writing Committee) on Use of Intravenous tPA for Ischemic Stroke:; Brown MD, Burton JH, Nazarian DJ, Promes SB. Ann Emerg Med. Erratum in: Ann Emerg Med. doi: 10.1053/j.sult.2013.01.004.

Stroke 107

Stroke EMS EKG/ECG Radiology 107

Dr. Smith's ECG Blog

JANUARY 10, 2020

He had this ECG at time 0 What do you think? There was an old ECG for comparison: Very normal Interpretation: There is serious widespread ST elevation that could easily by due to a wraparound LAD with anterior and inferior MI. Another ECG was recorded at 1.5 ng/mL Another ECG was recorded at 3.5 Learning Points: 1.

EKG/ECG 40

EKG/ECG Ultrasounds Emergency Department Wellness 40

Taming the SRU

FEBRUARY 23, 2024

Clinical pathologic case presentation - r1 diagnostics/therapeutics: Lumbar punctures - AIRWAY GROUND ROUNDS- r4 capstone - r3 taming the sru - ultrasound grand rounds Clinical pathologic case presentation WITH Drs. Consider starting more goals of care discussions in the emergency department, not just for patients who are actively dying.

Pediatrics 75

Pediatrics Ultrasounds Fractures Wellness 75

Dr. Smith's ECG Blog

JULY 7, 2013

Here is his ECG: There is atrial fibrillation at a rate of 95. If detected early by ultrasound, the patient can be saved. Our own Dave Plummer of HCMC reported on survival of 2 of 6 patients with free wall myocardial rupture diagnosed by bedside ultrasound in the ED.(3) This was the 12-lead ECG. There was some SOB.

Ultrasounds 52

Ultrasounds EKG/ECG Emergency Department Shock 52

Dr. Smith's ECG Blog

JULY 18, 2014

Here is his ECG: What is your interpretation? This was the 12-lead ECG. This remains consistent with PIRP, as was the first ECG. If detected early by ultrasound, the patient can be saved. He found 2 ECG patterns of atypical T-wave development in PIRP: 1) persistently positive (upright) T-waves 48 hours after AMI onset.

EKG/ECG 52

EKG/ECG Shock Ultrasounds Wellness 52

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). A followup ECG was recorded 2 days later: No definite evidence of infarction. Smith — “ S hark F in” m orphology was noted on the initial monitoring strip, and initial 12-lead ECG.

CPR 52

CPR EKG/ECG Shock Ultrasounds 52

Dr. Smith's ECG Blog

NOVEMBER 12, 2020

He had the following EKG recorded: Low voltage, suggests effusion. A bedside cardiac ultrasound was normal, with no effusion. He was started on Extracorporeal Life Support ("VA ECMO") Here is the ECG on ECMO: Very low voltage On Day 3, the EF recovered (that seems quick!) He was moderately hypoxic.

Shock 52

Shock EKG/ECG Outcomes Hospitals 52

ACEP Now

AUGUST 12, 2024

Every 30 minutes, a range of topics draws new participants to discuss everything from mastering ultrasound techniques to finding career mentorship. Get a personal financial plan, immerse yourself in hands-on training, brush up on your ultrasound and more. Emergency Ultrasound Management Course: (Sept. 28: 10 a.m.–5

Ultrasounds 52

Ultrasounds Research Radiology Radiology 52

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

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

Dr. Smith's ECG Blog

NOVEMBER 3, 2017

Beware of using it to reverse your prior opinion that the ECG represents LAD occlusion. I recommend using it when you are worried that an ECG with apparent normal ST Elevation might be LAD occlusion. Case 3 I was reading a stack of ECGs yesterday, and saw this one, with no clinical information. Sensitivity is not perfect.

EKG/ECG 52

EKG/ECG Outcomes Emergency Department Ultrasounds 52

Dr. Smith's ECG Blog

NOVEMBER 28, 2022

Written by Destiny Folk MD, with edits by Meyers, peer reviewed by Smith and Grauer A woman in her late 20s with a past medical history of cervical cancer status post chemotherapy and radiation therapy presented to the emergency department for shortness of breath, chest tightness, and two episodes of syncope. Her pulse is 125.

EKG/ECG 40

EKG/ECG Ultrasounds Documentation/Coding COPD 40

EB Medicine

JUNE 6, 2019

CT is good but you really should learn ultrasound, and lastly, sick patients need prompt consultation and resuscitation, not rapid trips to radiology. Nachi: Diagnosis of appendicitis, in a pregnant patient, ultrasound vs. mri. Jeff: Next we have everybody’s favorite, the ultrasound. Sounds familiar. Jeff: We sure did!

Ultrasounds 40

Ultrasounds Radiology Radiology Sepsis 40

Pediatric Emergency Playbook

DECEMBER 1, 2015

Ultrasound can be used to troubleshoot when needed. Regardless of the exposure, obtain an ECG and look for bundle branch block, heart block, and dysrhythmias , since those will change disposition. Discharge patients with low-voltage injury, no symptoms, and a normal ECG. Mattu M, Swadron SP (eds). Phiadelphia.

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Burns EKG/ECG Emergency Department Shock 40