Emergency Medicine Cases

OCTOBER 8, 2019

The post EM Quick Hits 9 Burn Blister Debridement, ECG Cases, Compartment Syndrome, Pediatric Asthma, Spinal Trauma, Motivational Interviewing P2 appeared first on Emergency Medicine Cases.

Burns 52

Burns Pediatrics EMS EKG/ECG 52

Dr. Smith's ECG Blog

JANUARY 13, 2024

The next morning, the following ECG was obtained. If it does not sense a native rhythm (perhaps from lead fracture or displacement), it will attempt to pace at 60 beats per minute, which can cause unnecessary pacing spikes interrupting normal cardiac function. Repeat ECG from the emergency department is shown. What do you think?

EKG/ECG 111

EKG/ECG Hospitals Fractures Emergency Department 111

JournalFeed

JUNE 13, 2020

We cover false negative SARS-CoV-2, overdoing pediatric radius fracture reduction, crystalloid harm for pediatric hemorrhage, hyperangulated vs. standard-geometry laryngoscopy, and early ECG warning of RV strain prior to PEA/asystole. Here is the JournalFeed Podcast for the week of June 8-12, 2020.

EKG/ECG 52

EKG/ECG Fractures Pediatrics 52

EMergucate

SEPTEMBER 13, 2024

The pelvic x-ray shows a fracture of the right ilium. There are ecg leads visible and an external artifact likely … Continue reading →

Fractures 52

Fractures EKG/ECG EMS 52

Dr. Smith's ECG Blog

NOVEMBER 25, 2022

As a routine part of his critical trauma evaluation, he had an ECG recorded: There is an rSR" in V1 and V2, with downsloping ST segment and inverted T-wave which is very similar to a Brugada Type 1 phenocopy. On the other hand, the RV lies directly under leads V1 and V2; this makes pneumothorax less likely as an etiology of the abnormal ECG.

EKG/ECG 52

EKG/ECG Fractures Hyperthermia / Hypothermia Wellness 52

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.

EKG/ECG 52

EKG/ECG Sepsis Documentation/Coding Stroke 52

EM Curious

JULY 8, 2015

US GUIDED ULNAR NERVE BLOCK [BLOG]: Boxer's fracture need a reduction? CARDIOLOGY NUGGETS CASE OF A 59 Y/O M APPEARING UNWELL [BLOG]: You must learn to recognize these ecg patterns, and have a practical ecg reading algorithm. Part 1 here. Consider an ultrasound guided ulnar nerve block.

Infectious Diseases 52

Infectious Diseases Disaster Management Sepsis Ultrasounds 52

Dr. Smith's ECG Blog

AUGUST 17, 2022

I saw this EKG when reading through the system: What do you think? RBBB and STD ECGs with RBBB have non-ischemic ST depression in V1-V3, discordant to a positive R'-wave; this STD is very moderate, and when "excessive," it represents ischemia, as it does here. She had some fractures. Figure-1: The initial ECG in today's case.

EKG/ECG 52

EKG/ECG Fractures 52

EB Medicine

MARCH 1, 2019

Again, no standard definition exists, with some diagnostic criteria including simply chest pain and increasing cardiac enzymes, and others including cardiac dysfunction, ecg abnormalities, wall motion abnormalities, and an elevation of cardiac enzymes. New EKG findings requires admission for monitoring. of those patients.

Emergency Department 40

Emergency Department EKG/ECG Operations Fractures 40

Dr. Smith's ECG Blog

JULY 3, 2020

This ECG was done in a middle aged woman who was in a motor vehicle collision in which her vehicle "T-boned" another, so there was trauma to the anterior chest. She had multiple rib fractures as well as serious hemorrhage and underwent massive transfusion. ng/mL, and an ECG was recorded: There are no P-waves visible.

Blood Transfusions 52

Blood Transfusions EKG/ECG Shock Fractures 52

EM Curious

MAY 27, 2015

THE SUPERIOR CERVICAL PLEXUS BLOCK [VIDEO]: AKA THE SCP Block , a useful nerve block technique for your ear laceration, central line placement and even a clavicle fracture. Dr. Smith's ECG Blog See you next week Nice post EM Docs post discussing the pro ketamine/rocuronium camp. Check it out here.

EMS 52

EMS Shock EKG/ECG Pediatrics 52

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! Check out this video at the new CORE EM website regarding the tongue blade test to assist with your decision making. Check out his post here.

EMS 52

EMS Ultrasounds EKG/ECG Fractures 52

ALiEM

FEBRUARY 28, 2024

We also must recognize the important contributions of media such as clinical photographs, radiology images, and ECGs. Photographs, ECGs, Radiology Images These fall into the category of “other multimedia” in the AMA Manual of Style, and here is my best attempt to interpret this to clinical media. Accessed February 20, 2024.

Radiology 52

Radiology Radiology Academics Fractures 52

Taming the SRU

FEBRUARY 23, 2024

Location of the block will determine the morphology of the QRS (as a higher block may have a narrow QRS with a rate of 40-60bpm) Evaluation in the ED: basic labs including BMP and troponin, EKG, bedside echo, CXR Management: Atropine: push-dose 0.5-1mg,

Pediatrics 75

Pediatrics Ultrasounds Fractures Wellness 75

EM SIM Cases

NOVEMBER 12, 2022

As soon as tPA is pushed, the resident will be handed an EKG with signs of hyperkalemia and told that a patient with depression has checked in. The trauma will be an open book pelvic fracture with hypotension and a positive FAST. As they are pushing the medications, a Trauma Level One will be called.

Resuscitation 40

Resuscitation Stroke EKG/ECG Fractures 40

PEMBlog

OCTOBER 18, 2024

Orthopedic Risks: Watch for Fat Embolism DMD patients are prone to fat embolisms following fractures due to the fatty infiltration of their bone marrow. Any trauma that results in fractures should raise immediate concern for fat embolism syndrome, which can present rapidly and lead to respiratory and cardiovascular complications.

Emergency Department 52

Emergency Department Fractures Best Practices Documentation/Coding 52

Taming the SRU

MARCH 17, 2023

mg/kg IV Versed: 0.2 mg/kg IM, 0.2 mg/kg IN (may repeat to max of 0.4 mg/kg IN), 0.2

Seizures 40

Seizures Fractures Burns Pediatrics 40

Taming the SRU

DECEMBER 6, 2023

Calcium is also now carried in the prehospital setting and should be used when EKGs show signs of hyperkalemia, cardiac arrest with concern for hyperkalemia, and those who have crush injuries. Occult fractures exist, therefore a high index of suspicion for these injuries is necessary, even in the setting of initially negative plain films.

Leadership 57

Leadership Stroke Airway Management Administration 57

ACEP Now

MARCH 14, 2024

1,4-5 Thus, an electrocardiogram (ECG) and cardiac monitoring should be performed for unstable, electrical injury patients. 7 Thus, an ECG is recommended for all electrical injuries. His ECG was unremarkable. Syncope can also occur due to disruption of central nervous tissue.

Burns 52

Burns Fluid Resuscitation EKG/ECG EMS 52

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. Cerebral salt wasting syndrome, peripheral nerve lesions, spinal cord fracture, and cerebral hemorrhages have all been described.

Emergency Department 40

Emergency Department Burns EKG/ECG Shock 40

RebelEM

MARCH 9, 2023

Assess for blood in the nares or signs of basal skull fracture, including battle signs, raccoon eyes, or hemotympanum. Check that clavicles are intact and that there are no obvious rib fractures or spinal step-offs. After your primary ABCs assessment, consider “D” for dextrose and check for occult hypoglycemia.

Psychiatric 52

Psychiatric Emergency Department Fractures Documentation/Coding 52

Mind The Bleep

JUNE 18, 2023

It is important to complete an ECG prior to initiating pharmacological therapy as drugs, such as antipsychotics can prolong the QT interval, increasing the risk of arrhythmias. If there is no benefit this should be stopped. Least restrictive options should be considered, with a risk versus benefit assessment in regards to medication.

Psychiatric 52

Psychiatric Documentation/Coding Stroke Fractures 52

Taming the SRU

FEBRUARY 22, 2023

HIV related renal disease HIV Associated Nephropathy (HIVAN) Form of FSGS Renal recovery can occur with ART Can occur prior to HIV seroconversion HIV Immune Complex Kidney Disease Less common than HIVAN Develops later in disease course Better prognosis Dermatologic Manigfestations of HIV HIV Associated Facial molluscum in an adult Proximal subungual (..)

Hospice 40

Hospice EKG/ECG Resuscitation Seizures 40

EB Medicine

JUNE 6, 2019

Nachi: And as a brief aside, before we continue… Missed appendicitis is one of the three most common causes of emergency medicine malpractice lawsuits - with MI and fractures being the other two. Nachi: And finally let’s touch upon the ekg and ACS. An EKG and troponin should be considered. If inconclusive, order an MRI.

Ultrasounds 40

Ultrasounds Radiology Radiology Sepsis 40

Rural Doctors Net

AUGUST 30, 2013

Pull straight any fractures & splint them. Monitors should be visible to the team leader and should include : SpO2 ETCO2 Anaesthetic gases NIBP Pulse, ECG Temperature I’d place an arterial line, NGT & IDC once in the ED or OT. Wrap the pelvis – use a proper binder if there is ANY concern re: a pelvic injury.

Burns 52

Burns Hospitals Ambulance Services Wellness 52

EMDocs

OCTOBER 7, 2023

neurologic damage and thrombosis) 20,21 Resuscitation Lactated ringers > Normal saline due to reduced need for urinary alkalinization 22 Place foley and target urine output >300 mL/hr Electrolyte abnormalities Hyperkalemia: Obtain an ECG Stabilization: Calcium gluconate 2 g over 5-10 min.

EMS 92

EMS Fluid Resuscitation Fractures Resuscitation 92

ACEP Now

MARCH 11, 2025

Musculoskeletal complications include osteopenia with increased risk for long bone fractures. I recommend an order set that includes ECG, glucose, creatinine, liver enzymes, lipase, amylase, electrolytes including calcium, magnesium, and phosphate ketones, and urinalysis. 16 An elevated amylase suggests repetitive vomiting as well.

Emergency Department 52

Emergency Department Psychiatric Dehydration Pediatrics 52

Dr. Smith's ECG Blog

JANUARY 21, 2023

ECG met STEMI criteria and was labeled STEMI by computer interpretation. What is your ECG interpretation, and would you activate the cath lab? This ECG shows a sinus bradycardia with a normal conduction pattern (normal PR, normal QRS, and normal QTc), normal axis, normal R-wave progression, normal voltages. What do you think?

Hyperthermia / Hypothermia 52

Hyperthermia / Hypothermia EKG/ECG Seizures Fractures 52

EMDocs

SEPTEMBER 16, 2024

I think we should probably do some tests or something, like an ECG, maybe? I would also like to get an EKG to look for any arrhythmias or ST elevations or depressions. Additionally, I would like to get a chest XR to look for any evidence of pneumonia, pneumothorax, pericardial or pleural effusion, widened mediastinum, or fracture.

EKG/ECG 87

EKG/ECG Wellness Fractures Emergency Department 87

EMDocs

NOVEMBER 4, 2024

Costochondritis, rib fractures, and pericarditis are common causes of chest pain that can be treated with multimodal regimens. 7 Rib and Sternal Fractures: Rib fractures are often caused by blunt chest trauma. Up to two-thirds of rib fractures are missed on initial chest radiographs. Most cases abate by one year.

Emergency Department 105

Emergency Department Fractures Burns EMS 105

Taming the SRU

AUGUST 25, 2023

doxycycline Consider a splint/cast window to allow direct monitoring mainly used for fracture blisters and/or open wounds yet takes away from the strength of the splint/cast Case #3 43yo with FOOSH injury and closed wrist deformity, yet no x-ray machine is available to you Least likely injuries to need an x-ray in a resource-limiting setting?

Seizures 75

Seizures Fractures EKG/ECG Resuscitation 75

EMDocs

FEBRUARY 18, 2025

Authors: Lloyd Tannenbaum, MD (EM Attending Physician, Geisinger Wyoming Valley, PA) // Reviewer: Brit Long, MD (@long_brit) Hello and welcome back to ECG Pointers, a series designed to make you more confident in your ECG interpretations. This week, we feature a post from Dr. Tannenbaums ECG Teaching Cases , a free ECG resource.

EKG/ECG 63

EKG/ECG Documentation/Coding Wellness CPR 63

Dr. Smith's ECG Blog

MARCH 8, 2025

She sustained a large scalp hematoma along with several rib and vertebral fractures, but with CT scanning of chest/abdomen/pelvis/C-T-L-spine and head, no life threatening injuries were found. Her first ECG is shown. After this ECG was obtained, the ER physician received word that the patient's husband had died in the crash.

EKG/ECG 77

EKG/ECG CPR Resuscitation Wellness 77

Taming the SRU

JUNE 6, 2023

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

Documentation/Coding 64

Documentation/Coding Seizures Psychiatric Wellness 64

EM Literature of Note

FEBRUARY 17, 2025

So, check out: The Journavx Hype Predicting Heart Failure from ECGs Whats the Best Fluid for Pancreatitis? Reviving High-Dose Oxygen Therapy After Stroke Do Facial Fractures Require Antibiotic Prophylaxis? A Nice Win for Radiology AI Where Endovascular Treatment Fails Even the Best Make Terrible Alerts The Future of AI is FUTURE-AI?

Anaphylaxis 57

Anaphylaxis Radiology Radiology Stroke 57

ACEP Now

NOVEMBER 7, 2024

TCAD should be considered in a young person with a history of recent chest trauma followed hours to weeks later with anginal symptoms plus any combination of ischemic ECG changes, troponin elevation, or wall motion abnormalities on point-of-care ultrasound (POCUS).

EKG/ECG 52

EKG/ECG Fractures Emergency Department Ultrasounds 52

Mind The Bleep

NOVEMBER 2, 2024

If you are concerned that the clavicle may be fractured then arrange an x-ray and discuss the findings with the orthopaedics team. Request an ECG for the baby if ANY murmur is identified. Look at and palpate the clavicles for any bruises, bony deformity or abnormal arm positions as this could be a sign of clavicular injury.

Dislocations 52

Dislocations Documentation/Coding Ultrasounds Wellness 52