EM SIM Cases

NOVEMBER 20, 2023

Dr Brad Stebner is a staff Emergency physician in Kelowna, BC, Clinical Instructor at UBC and one of our editors at EM Sim Cases. WHY IT MATTERS Classic heat stroke is a potentially deadly diagnosis that effects some of the most vulnerable of our populations.

Stroke 52

Stroke Hyperthermia / Hypothermia EMS EKG/ECG 52

Dr. Smith's ECG Blog

APRIL 2, 2024

Here is the initial ED ECG. Other thought this was due to hyperkalemia, but the ECG does not have the appearance of hyperkalemia but does have the appearance of severe cardiomyopathy -- LBBB with very wide QRS) 3. Another ECG was recorded 12 minutes later: Paced rhythm, probable Pacemaker-Mediated Tachycardia ?

EKG/ECG 135

EKG/ECG Shock CPR Stroke 135

The Skeptics' Guide to EM

OCTOBER 5, 2019

Prehospital transdermal glyceryl trinitrate in patients with ultra-acute presumed stroke (RIGHT-2): an ambulance-based, randomized, sham-controlled, blinded, phase 3 trial. He’s been involved in EMS for over 30 years in a variety of roles and is a strong advocate for evidence-based EMS protocols. The Lancet March 2019.

Stroke 52

Stroke Hospitals EMS Outcomes 52

Dr. Smith's ECG Blog

SEPTEMBER 2, 2024

Her husband called EMS when the patient experienced new onset seizures accompanied by micturition. The ECG below was recorded by EMS. ECG #1 Interpretation: ECG #1 shows sinus rhythm at a heart rate of 77 bpm. At first glance, the ECG does not look too abnormal. All patients with seizures needs an ECG.

Seizures 111

Seizures EKG/ECG EMS Stroke 111

The Skeptics' Guide to EM

MARCH 2, 2024

His vital signs are all normal and the ECG done at triage does not show an occlusive myocardial infarction. He will need to be transferred to the tertiary care center which is 35 minutes away by ground EMS if it is a dissection. Case: A 59-year-old man walks into your community emergency department (ED) complaining of chest pain.

Emergency Department 118

Emergency Department Stroke Operations Hospitals 118

Taming the SRU

AUGUST 7, 2023

The patient needs a transvaginal ultrasound w/ doppler with gynecology consult and possible laparotomy TVUS is not just for torsion, it can also be used for ectopic pregnancies or pregnancy of unknown location Acute Ischemic Stroke Updates WITH Drs. The expanded window of 3-4.5 hours increased the NNT for a good outcome to 20.

Stroke 93

Stroke Outcomes EKG/ECG Research 93

ACEP Now

JUNE 6, 2023

ECG, CXR, and troponin are negative. Notoriously elusive, with a high misdiagnosis rate, thoracic aortic dissection (AD) can mimic many conditions, including acute coronary syndrome (ACS, the most common), gastroesophageal reflux disease (GERD), stroke, and spinal-cord compression. EMS is called and finds his blood pressure 175/100.

EKG/ECG 85

EKG/ECG Stroke Documentation/Coding Operations 85

Dr. Smith's ECG Blog

DECEMBER 26, 2020

An ECG was recorded quickly on return to the ED: (sorry for poor quality, cannot get originals) What do you think? They called their transfer center cardiologist on call, who reviewed the case on the phone with them, as well as the ECG. The EM provider asked if the cardiologist thought it was a "STEMI."

EKG/ECG 52

EKG/ECG Stroke Administration Seizures 52

ACEP Now

JULY 7, 2023

Post-resuscitation ECGs demonstrating ST segment elevation are significant in delineating which patients might benefit most from advanced reperfusion techniques. Post-resuscitation ECGs demonstrating ST segment elevation are significant in delineating which patients might benefit most from advanced reperfusion techniques. Circulation.

Resuscitation 98

Resuscitation Shock Stroke Hospitals 98

EMDocs

SEPTEMBER 19, 2023

Episode 86: Tricky Cases Part 2 Case 3: 56-year-old female with history of seizures, actively seizing, EMS called. Patient seized for approximately 20 minutes prior to EMS arrival. “The application of STEMI ECG criteria on a standard 12-lead ECG alone will miss a significant miry of patients who have acute coronary occlusion.”

Seizures 72

Seizures Documentation/Coding EKG/ECG Emergency Department 72

RebelEM

MARCH 22, 2023

Differential to Consider (for Regular, Narrow Complex Tachydysrhythmias) Sinus Tachycardia AVNRT Orthodromic Atrioventricular Reentrant Tachycardia (AVRT) Atrial Flutter with 2:1 block Common EKG Findings Narrow-complex, regular rhythm with a rate that often exceeds the theoretical maximal heart rate (220 – age) for that patient.

EKG/ECG 52

EKG/ECG EMS Pediatrics Stroke 52

EM SIM Cases

NOVEMBER 12, 2022

EM physicians are required to task switch numerous times, often assessing a new patient immediately after critical interventions have been implemented on their current patient. The exact moment these orders are completed, a stroke activation will be called for a patient eligible for tPA.

Resuscitation 40

Resuscitation Stroke EKG/ECG Fractures 40

Taming the SRU

JULY 31, 2024

However, believers in this superstition will perceive crazier shifts if the word is uttered so you probably shouldn’t say it, or use cautiously Full moons have no impact on ED, EMS, or HEMS volumes or acuity. Nice people are not more likely to get cancer. Black clouds don’t exist (but I still sort of think they do).

EKG/ECG 52

EKG/ECG Sepsis Documentation/Coding Stroke 52

Taming the SRU

DECEMBER 6, 2023

ems grand rounds: southwest ohio protocol updates WITH dr. weekley Ideally, medications will be administered IV or IO, therefore endotracheal tube drug administration will be de-emphasized. If there is no improvement in 20 minutes, EMS will call medical control regarding further decisions. Remember who you are and who you represent.

Leadership 57

Leadership Stroke Airway Management Administration 57

Dr. Smith's ECG Blog

OCTOBER 7, 2019

This is by one of our outstanding 3rd year residents , Aaron Robinson, with some edits and comments by Smith EMS responded to a reported seizure in a 42 year old male. One of our EMS Fellows along with a Senior EM Resident were on duty that evening, and arrived on the scene with the Fire Department. Why is the patient in shock?

Seizures 40

Seizures EKG/ECG Shock EMS 40

The Skeptics' Guide to EM

SEPTEMBER 19, 2020

Alongside his EM residency, he is doing a PhD in epidemiology. Alongside his EM residency, he is doing a PhD in epidemiology. Audrey Marcotte are Chief Residents from the Royal College of Emergency Medicine Program at McGill University. Robert’s academic interests include research and evidence-based medicine.

Academics 52

Academics Resuscitation EMS Stroke 52

Taming the SRU

AUGUST 4, 2024

In select patient populations (such as those with poor outpatient follow-up), screening with a BMP to evaluate their serum creatinine may be beneficial Patients with asymptomatic hypertension should be referred to their PCP for outpatient follow-up.

Emergency Department 85

Emergency Department Dislocations Documentation/Coding Burns 85

Kings County Downstate EM

MARCH 16, 2023

Co-authors: Paul Lavadera and Esteban Davila Peer Editor: Alec Feuerbach Faculty Editor: Mark Silverberg The Case A 65-year-old male with a history of hypertension, hyperlipidemia, diabetes, hypertrophic cardiomyopathy, recent stroke, and atrial fibrillation (AF) (+anticoagulation) presented to the ED for syncope.

Stroke 40

Stroke EMS EKG/ECG 40

Dr. Smith's ECG Blog

MARCH 15, 2023

Here is her EKG: What is unusual about this? Here is the ECG after ibutilide: What do you notice? Here is the post-cardioversion ECG: Sinus rhythm, still with the longer QT interval. For more on SSS — See My Comment at the bottom of the page in the July 5, 2018 post in Dr. Smith’s ECG Blog. She was on no medications.

EKG/ECG 52

EKG/ECG Dehydration Stroke Wellness 52

EM SIM Cases

NOVEMBER 3, 2023

Jared Baylis and Dr. Kelly Huang Dr. Baylis is the Simulation Medical Director at University of British Columbia – Southern Medical Program and Interior Health, as well as an editor of EM Sim Cases. Heat Related Illness Download ECG Curtesy of Life in the Fast Lane, ECG Library for sinus tachycardia.

Hyperthermia / Hypothermia 52

Hyperthermia / Hypothermia EKG/ECG EMS Hospitals 52

Ziqitza HealthCare Ltd

JULY 14, 2023

Often, the blood vessels of such patients become narrow or blocked, leading to chest pain, heart attacks, or strokes, eventually resulting in death. In Conclusion Public-private partnerships between state governments and private EMS providers have, however, played a major role in reducing deaths due to cardiac diseases in India.

Ambulance Services 52

Ambulance Services Basic Life Support Operations Stroke 52

Dr. Smith's ECG Blog

AUGUST 23, 2017

Here is his 12-lead ECG: The computer reads supraventricular tachycardia. Same stroke precautions as atrial fib A 40-something presented with palpitations and had a regular pulse at 170. What is it? It is atrial flutter with 2:1 conduction. It is not PSVT and not sinus. There are clear flutter waves in lead II across the bottom.

Stroke 52

Stroke Sepsis Emergency Department EMS 52

EB Medicine

JANUARY 10, 2020

Show More v Please click here and take our listener survey Part 1: Definitions Myocardial Infarction: elevated cardiac biomarkers (aka troponin) with clinical evidence of acute myocardial ischemia (aka signs and symptoms, ECG changes, abnormal imaging, or coronary thrombosis at cath or autopsy). Diagnostics Telemetry ECG.

Emergency Department 40

Emergency Department EKG/ECG Shock Sepsis 40

Dr. Smith's ECG Blog

MARCH 6, 2019

This ECG was recorded on arrival: What do you think? Proof that all STE and hyperacute T-waves in the presentation ECG are new. They collected several repeat ECGs at the outside hospital before transport: None of these three ECGs meet STEMI criteria. This ECG shows persistent Occlusion MI but does not meet STEMI criteria.

EKG/ECG 52

EKG/ECG Outcomes Hospitals Wellness 52

Dr. Smith's ECG Blog

AUGUST 3, 2018

Nurses found him with a BP of 50/30 and heart rate of 130 and called EMS. Here was his prehospital ECG, which I viewed immediately while the resident performed cardiac ultrasound: What do you think? Here is the cardiac ultrasound which the resident performed as I viewed the ECG: This shows a huge pericardial effusion.

EKG/ECG 40

EKG/ECG Ultrasounds Stroke Shock 40

ACEP Now

APRIL 5, 2024

1 However, many clinical features are common: more than 60 percent of patients present with a degree of neurological involvement, ranging from confusion to stroke and coma. 1 25 percent of patients may present with evidence of myocardial ischemia, including abnormal ECGs and elevated troponin levels. J Clin Med. 2021;10(3):536.

Domestic Violence 40

Domestic Violence Emergency Department Outcomes EKG/ECG 40

EB Medicine

NOVEMBER 1, 2018

Jeff: Next, make sure that all patients with high voltage injuries have an EKG and continuous cardiac monitoring. Those with low voltage injuries and a normal EKG do not require monitoring. CNS dysfunction may be immediate or delayed and can range from strokes to spinal cord injuries. Let’s move on to treatment.

Emergency Department 40

Emergency Department Burns EKG/ECG Shock 40

Taming the SRU

MAY 1, 2023

EMS was bagging him on arrival Primary notable for Compromised Airway Protection, bilateral Breath sounds, strong pulses,GCS 3 CT images of Head, Chest, Abdomen, Pelvis, and Spine No acute findings pH of 6.75 Exertional Hyperthermia Patients with heat stroke will present with Temp > 104, AMS, or seizures.

Poisoning 52

Poisoning Hyperthermia / Hypothermia Emergency Department Seizures 52

ACEP Now

JULY 6, 2023

Emergency medicine (EM) has evolved over time and has long passed a crossroads where previously unachievable capabilities should be celebrated and shared.

Head Injuries 52

Head Injuries Emergency Department Research Pediatrics 52

EMDocs

DECEMBER 16, 2023

We’ll keep it short, while you keep that EM brain sharp. A 34-year-old male is brought via EMS after collapsing during an outdoor adventure race. EMS reports the patient was conscious but altered, with slurred speech and confusion. A 12-lead EKG shows sinus tachycardia but is otherwise normal. Temps greater than 41.5C

Hyperthermia / Hypothermia 68

Hyperthermia / Hypothermia EMS Stroke Seizures 68

Taming the SRU

JUNE 6, 2023

then need further evaluation Usually with CTA imaging If normal physical exam & ABI>0.9,

Documentation/Coding 64

Documentation/Coding Seizures Psychiatric Wellness 64

EMDocs

OCTOBER 27, 2023

On the monitors and subsequent ECG, you note he is in atrial fibrillation with rapid ventricular response. Further review reveals the patient was unable to afford his refill of Eliquis and abruptly stopped taking it, leading to his acute stroke. Exam shows an uncomfortable-appearing febrile gentleman with a mild cough.

Research 70

Research Stroke EMS EKG/ECG 70

EB Medicine

AUGUST 1, 2018

Nachi: Sometimes… Jeff: This month’s issue was authored by Mollie Williams, who is the EM residency program director at the Brooklyn Hospital Center. First up is the link between cannabis use and stroke or TIA. times higher risk of stroke or TIA. times higher risk of stroke or TIA. Effects can be seen within 3 minutes.

Seizures 40

Seizures Hyperthermia / Hypothermia Administration Dehydration 40

Dr. Smith's ECG Blog

APRIL 8, 2015

Abnormal ECG – looks for cardiac syncope. Abnormal Electrocardiogram (ECG): Defined (San Fran syncope rule) as any new changes when compared to the last ECG or presence of non-sinus rhythm. If no previous ECG was available, ECG was classified as abnormal if any abnormality was present. orthostatic vitals b.

Emergency Department 52

Emergency Department EKG/ECG Outcomes Seizures 52

EMDocs

NOVEMBER 4, 2024

Bhana, MD (EM Resident Physician, University of Massachusetts/UMass Chan Medical School); Clarence Kong, MD (Pain Fellow, Eastern Virginia Medical School – Virginia Health Sciences at Old Dominion University); Mani Hashemi, MD (EM Attending, HCA Florida Mercy Hospital); S.M. 2017.04.011 Witt CE, Bulger EM. Authors: Nikhil B.

Emergency Department 99

Emergency Department Fractures Burns EMS 99

Taming the SRU

NOVEMBER 18, 2024

Other causes include gastritis, gastric malignancy, pancreatitis, hiatal hernia, SBO, large meal, spicy foods, and carbonated drinks Neurologic Stroke, space occupying lesion, epilepsy, CNS infection, demyelinating and neurodegenerative disorders such as multiple sclerosis and Parkinson’s disease are causes of intractable hiccups.

Stroke 81

Stroke Administration Dehydration COPD 81