Taming the SRU

AUGUST 7, 2023

Demel and kreitzer Expanding indications for Thrombolytics Initial tPA window of 0-3 hours number needed to treat (NNT) to achieve a good outcome was 10. hours increased the NNT for a good outcome to 20. Research Grand rounds WITH Drs. The expanded window of 3-4.5

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Stroke Outcomes EKG/ECG Research 93

Taming the SRU

OCTOBER 5, 2023

morbidity and mortality - quality improvement - research grand rounds - r1 clinical knowledge: pres/rcvs - r4 case follow-up: compartment syndrome Morbidity and Mortality WITH dr. finney Takotsubo Cardiomyopathy with COVID-19 Increasing incidence of Takotsubo Cardiomyopathy with the COVID-19 pandemic Morbidity and mortality is similar to that of ACS (..)

Stroke 91

Stroke EKG/ECG Seizures CPR 91

Sensible Medicine

AUGUST 21, 2023

On yesterday’s podcast , I talked with Bobby Yeh, an academic cardiologist who made a compelling case for enhancing credibility of observational research. The reasons are multiple, but I will articulate a few: Most epidemiological studies are done from large data sets that are not collected for the purpose of research.

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Administration Outcomes Research COPD 98

Mind The Bleep

NOVEMBER 12, 2023

12 lead ECG: variable findings but LVH, pathological Q waves, ST and T wave abnormalities are common. The following are possible ECG changes you may expect to see: Figure 3 : An ECG illustrating the changes in HCM. ECG example (3): Figure 4 : ECG illustrating the changes in non-ischaemic dilated cardiomyopathy.

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EKG/ECG Research Outcomes 96

Dr. Smith's ECG Blog

APRIL 21, 2023

Written by Jesse McLaren, with comments from Smith A 50-year old patient on the medical wards developed acute chest pain, with an ECG labeled (see computer interpretation at the top) and confirmed as normal. I sent the ECG to Dr. Meyers without any other information. What do you think? This is diagnostic of inferoposterior OMI.

EKG/ECG 52

EKG/ECG Outcomes Research Hospitals 52

Dr. Smith's ECG Blog

NOVEMBER 15, 2023

She has no previous cardiac history of which she is aware 911 was called and here is her Prehospital ECG: What do you think? link] Case continued She arrived in the ED and here is the first ED ECG. In comparison with the first ECG, I would guess that the artery is reperfusing. I don't know if her pain was getting better or not.

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EKG/ECG Ultrasounds Wellness Stroke 110

RebelEM

JULY 3, 2023

What They Did: Researchers conducted a multicenter, retrospective cohort study in three community hospitals and two freestanding emergency departments. Patients confirmed on ECG to have atrial fibrillation or atrial flutter Patients with HR >120 bpm. Population: Inclusion Criteria: Patients 18 years old or greater.

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Administration Outcomes Documentation/Coding Emergency Department 91

Dr. Smith's ECG Blog

JUNE 28, 2018

This ECG (ECG #3) was recorded immediately after the last episode of pain spontaneously resolved. Angiographic and clinical characteristics of patients with unstable angina showing and ECG pattern indicating critical narrowing of the proximal LAD coronary artery. Here is the first post-cath ECG (ECG #4).

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EKG/ECG Burns Research Outcomes 52

Dr. Smith's ECG Blog

NOVEMBER 30, 2022

Our first 12 lead ECG was then recorded at 0926. Another ECG was recorded 5 minutes later just before arrival at the hospital: Similar The patient was transported to a nearby suburban hospital with PCI capabilities while my partner cared for her. Smith: this ECG and clinical presentation is diagnostic of LAD Occlusion.

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EKG/ECG Emergency Department Ultrasounds Hospitals 52

Cook County EM Blog

APRIL 27, 2022

of patients had an ECG in the prior 6 months, 4% had a QTc >500 msec 26.4% of patients had an ECG within 24 hours of droperidol administration, 3% had a QTc >500 msec No clinically significant arrhythmias observed Discussion The article provides support for the safety of droperidol in low doses in the ED. Am J Emerg Med.

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Administration EKG/ECG Emergency Department EMS 52

RebelEM

MARCH 13, 2023

Nevertheless, mortality of prehospital traumatic cardiac arrest (TCA), and survivability with good neurologic outcome, remain the gold standards of trauma care in and out of the hospital and are effectively the criterion by which we measure outcomes in the trauma literature. Discussion: Dead On Scene: The 96.2% mortality rate and 43.5%

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Basic Life Support EMS Outcomes Resuscitation 52

The Skeptics' Guide to EM

APRIL 21, 2018

The EKG and laboratory tests are normal. Comparison: None * Outcome: Diagnostic accuracy of various tests, features of aortic dissection and clinical decision instruments (sensitivity, specificity and likelihood ratios). His research program focuses on improving recognition and. This is an SGEMHOP episode.

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Emergency Department Academics EKG/ECG Research 52

The Skeptics' Guide to EM

SEPTEMBER 19, 2020

Robert’s academic interests include research and evidence-based medicine. Robert’s academic interests include research and evidence-based medicine. TXA also seems to improve patient-oriented outcomes in epistaxis ( SGEM#53 and SGEM#210 ). Alongside his EM residency, he is doing a PhD in epidemiology.

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Academics Resuscitation EMS Stroke 52

Dr. Smith's ECG Blog

MARCH 9, 2023

Here is his triage ECG at 0343: What do you think? Annals of Emergency Medicine Cardiology was called to evaluate the patient immediately for emergent cath, but they stated that the ECG did not meet STEMI criteria and elected to wait for further information before proceeding with cath. Vitals were within normal limits. hours earlier?

EKG/ECG 52

EKG/ECG Outcomes Emergency Department Research 52

Dr. Smith's ECG Blog

OCTOBER 28, 2013

The following 12-lead ECG was recorded at 11 minutes after ROSC. at the time of the ECG. Here is the annotated ECG from above, with lines drawn. Here is an article I wrote: Updates on the ECG in ACS. The last section is a detailed discussion of the research on aVR in both STEMI and NonSTEMI. Mg was 1.6.

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EKG/ECG CPR Resuscitation Research 52

Dr. Smith's ECG Blog

OCTOBER 3, 2018

The medics recorded the following initial ECG at time 0: The computer read (see below) gives no further comment beyond ventricular pacemaker. He refused to listen to the medic and was convinced that the ECG was due to hyperkalemia and that acute MI cannot be diagnosed in the presence of paced rhythm. What do you think?

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EKG/ECG Emergency Department Research Outcomes 52

PHEM Cast

APRIL 10, 2016

And from our buddies at HEFT EM CAST: [link] A bit more detail covering some of the research in an easy to understand way. This was the same principle as in the Rivers trial: the standard care group is the ‘control’ group against which changes in outcome for the ‘intervention’ group are compared. 2006 Jun 3;332(7553):1295–8.

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Sepsis Fluid Resuscitation Resuscitation Emergency Department 52

Dr. Smith's ECG Blog

JULY 31, 2018

Here was her ECG at time zero: What do you think? The physicians told me that they "knew something was wrong" with the ECG, but couldn't express exactly what. But this is what you are looking for if you do an ECG after pain resolution!! hours of substernal chest pressure. She had zero CAD risk factors. You MUST look for it.

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EKG/ECG Hospitals Research Outcomes 52

AED Leader

OCTOBER 25, 2023

VF is a critical medical emergency, demanding prompt treatment to ensure the best possible outcome. Note: Researchers are still unraveling the complexities of CPVT and its genetic components. These tests can include: Electrocardiogram (Resting ECG). Typically, ECG results appear normal during rest periods.

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EKG/ECG Shock Ultrasounds Research 52

AED Leader

OCTOBER 25, 2023

VF is a critical medical emergency, demanding prompt treatment to ensure the best possible outcome. Note: Researchers are still unraveling the complexities of CPVT and its genetic components. These tests can include: Electrocardiogram (Resting ECG). Typically, ECG results appear normal during rest periods.

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EKG/ECG Shock Ultrasounds Research 52

The Skeptics' Guide to EM

JANUARY 7, 2023

We just said there is so much research being published every day. As Professor Altman said in the BMJ back in 1994; “we need less research, better research and research done for the right reasons.” You order an ECG and confirm the patient has atrial fibrillation (AF) with rapid ventricular response (RVR).

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Emergency Department Research Shock EKG/ECG 40

Taming the SRU

MAY 1, 2023

Patients must have EKG findings and meet one of a few other criteria (ie family history of sudden death, VF or VT episode, syncope, nocturnal agonal respirations) Most common in patients of Southeast Asian descent and the mean age of death from arrhythmia if untreated is in the 4th decade of life.

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Poisoning Hyperthermia / Hypothermia Seizures Emergency Department 52

Dr. Smith's ECG Blog

FEBRUARY 8, 2015

There was a good outcome. Suggestions on management: First , examine the ECG very closely for P-waves. We believe this represents a form of “toxicomythology” given the millions of doses of beta -blockers administered in the past to patients with hyperadrenergic states, and a paucity of evidence of adverse outcomes (12).

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Seizures Administration Outcomes Hospitals 52

Northwestern EM Blog

JANUARY 24, 2022

Hypocalcemia can be hinted at through history or by hints such as a prolonged QTc on an ECG. However, even subclinical hypothyroidism with an elevated TSH but normal T4 increases risk of poor outcomes due to effects on cardiac function. Critical Care Research and Practice. Sources: 1) Amrein K, Martucci G, and Hahner S.

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Anaphylaxis Shock Sepsis Resuscitation 52

Taming the SRU

FEBRUARY 22, 2023

doing the little things right, with the understanding that small gains are additive, and that details can be the difference between a good outcome and a poor one. Lesson 11 Find what you love to do and surround yourself with people who make you better at doing it.

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Hospice EKG/ECG Resuscitation Seizures 40

Dr. Smith's ECG Blog

MARCH 24, 2023

Below is the ECG. There’s minimal concave ST elevation in III which does not meet STEMI criteria, so this ECG is "STEMI negative". Use STEMI criteria to identify acute coronary occlusion: the ECG was STEMI negative 2. A repeat ECG was done on way to cath lab: "STEMI negative" again. What do you think? Stress test?

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EKG/ECG Research Emergency Department Outcomes 52

EMDocs

DECEMBER 16, 2023

A 12-lead EKG shows sinus tachycardia but is otherwise normal. BMC research notes , 8 , 758. Clinical characteristics and outcome of thyroid storm: a case series and review of neuropsychiatric derangements in thyrotoxicosis. The patient is agitated, not oriented, and becoming combative with ED staff. Temps greater than 41.5C

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Hyperthermia / Hypothermia EMS Stroke Seizures 87

EMDocs

JANUARY 6, 2024

His electrocardiogram (ECG) is shown below: His chest x-ray is shown below: The patient’s high sensitivity troponin I is elevated to 3,000, and his Brain-Natriuretic Peptide (BNP) is elevated to 14,000 ng/L. 15 Consider ACS in the differential for transplant patients and have a low threshold for ordering screening ECG/troponin.

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EMS Infectious Diseases Shock Emergency Department 80

EB Medicine

AUGUST 1, 2018

Jeff: This DEA designation limits the ability to do research and obtain federal funding for such research. Synthetics were initially developed in the 1980s largely for research purposes. Jeff: For any patient arriving with suspected cannabis or synthetic abuse, consider checking an EKG.

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Seizures Hyperthermia / Hypothermia Administration Dehydration 40

Dr. Smith's ECG Blog

APRIL 8, 2015

Cardiac Syncope ("True Syncope") Independent Predictors of Adverse Outcomes condensed from multiple studies 1. 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.

Emergency Department 52

Emergency Department EKG/ECG Outcomes Seizures 52

EMDocs

JANUARY 20, 2024

ECG shows ST-segment elevation in V3-V6 only with depression in aVR. It was first described in Japan in 1991, where researchers noted a balloon shape to the left atrium resembling a trap used to catch octopuses in Japan. Initial vital signs include BP of 157/80, HR of 96, RR 14, SpO2 of 97% on RA, T 37.5.

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EMS Fluid Resuscitation Shock EKG/ECG 93

Don't Forget the Bubbles

FEBRUARY 5, 2024

We suggest this list can help you discover relevant or interesting articles for your local journal club or allow you to keep a finger on the pulse of paediatric research. Although sedentary behaviours have been linked to decreased bone mass, there is limited research on how video gaming impacts bone health. Singh NV, et al. Pediatrics.

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Pediatrics Research Resuscitation Psychiatric 52

EMDocs

NOVEMBER 4, 2024

Pain can be associated with a friction rub on cardiac auscultation, a pericardial effusion on a bedside echocardiogram, or diffuse ST elevations on an EKG. A comprehensive, patient-centered approach to pain management ensures effective treatment across these diverse pain syndromes, ultimately improving patient outcomes. Am J Emerg Med.

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Emergency Department Fractures Burns EMS 105

Sensible Medicine

JANUARY 27, 2025

Doctors seek therapies that reduce the chance of bad outcomes. When treating patients with suspected coronary disease, typical bad outcomes to prevent are myocardial infarction (MI) and death due to heart disease. Nearly 90% of both groups had ECG stress tests at baseline. PCI in stable disease does not reduce events.)

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Outcomes EKG/ECG Documentation/Coding Academics 121

Dr. Smith's ECG Blog

MARCH 8, 2025

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. Repeat ECG was obtained immediately, just 24 minutes after the prior ECG: Given the context, my top differential diagnosis would be stress cardiomyopathy AKA takotsubo. Overall bland.

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EKG/ECG CPR Resuscitation Wellness 77

RebelEM

FEBRUARY 3, 2025

While ECGs play a central role in detecting STEMI, misinterpretations often occur, leading to unnecessary catheterization or missed diagnoses. In this study, researchers developed and validated an AI model aimed at improving the diagnosis of STEMI based on 12-lead ECGs. Annals of Emergency Medicine.

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EKG/ECG Emergency Department Outcomes Hospitals 79

Dr. Smith's ECG Blog

DECEMBER 29, 2024

Dizziness is so unlikely to be OMI without an obvious ECG, that I am going to pretend that this patient presented with chest pain. Anyone can get acid reflux and present with chest pain, no matter the appearance of their ECG, right?) In fact, our system falsely called many of the T-waves in this ECG as hyperacute.

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EKG/ECG Research Outcomes Hospitals 67