Dr. Smith's ECG Blog

SEPTEMBER 27, 2023

This was written by Magnus Nossen, from Norway, with comments and additions by Smith A 50 something smoker with no previous medical hx contacted EMS due to acute onset chest pain. Upon EMS arrival the patient appeared acutely ill and complained of chest pain. An ECG was recorded immediately and is shown below. How do you interpret the ECG? ECG#1 There is a regular tachycardia with a ventricular rate of about 180 bpm.

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EKG/ECG Resuscitation Academics EMS 117

NIOSH Science Blog

SEPTEMBER 27, 2023

As of 2019, more than 18 million people, 11.5 % of the United States workforce, were employed in healthcare settings. Everyday healthcare workers face hazardous work conditions due to exposures to infectious agents and hazardous drugs and chemicals.

Outcomes 111

Outcomes 111

St. Emlyn

SEPTEMBER 27, 2023

St.Emlyn's - Emergency Medicine #FOAMed Day one of the RCEM annual scientific conference in Glasgow 2023. Highlights and summaries of some the talks. #FOAMed @stemlyns The post Day 1 RCEM Annual Scientific Conference: Glasgow 2023. St Emlyn’s appeared first on St.Emlyn's.

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ECG Guru

SEPTEMBER 27, 2023

The patient: 4 week old female infant with past medical history of meconium aspiration at birth with APGAR scores of 2,4,6. Intubated and given nitric oxide for pulmonary hypertension. Weaned in NICU over 10 days. Echocardiogram during that time showed stiff pulmonic valve. This ECG was obtained at follow up appointment. Infant is eating well, no cyanotic spells.

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EKG/ECG Pediatrics Wellness 98

Emergency Live

SEPTEMBER 27, 2023

Celebrating Everyday Heroism: REAS 2023 Honours the Angels of the Road In the heart of autumn, in the first week of October to be precise, the emergency ecosystem in Italy will experience a moment of sharing, learning and recognition. The scene will be REAS, Salone Internazionale dell’Emergenza, which for the 2023 edition will open its […] The post REAS 2023: Driver of the Year Trophy appeared first on Emergency Live.

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Science Based Medicine

SEPTEMBER 27, 2023

Optimal nutrition can be a highly cost-effective, even net positive, government program. The post The Food Is Medicine (FIM) Movement first appeared on Science-Based Medicine.

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Emergency Live

SEPTEMBER 27, 2023

Nature awakens in the supervolcano area after a series of tremors During the night of Wednesday 27 September, nature decided to break the silence with a loud roar that shook the Campi Flegrei area. At 3.35am, an earthquake of magnitude 4.2 hit the region, marking the most intense seismic event in the last forty years […] The post Campi Flegrei earthquake: no significant damage, but concern grows appeared first on Emergency Live.

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RebelEM

SEPTEMBER 27, 2023

Take Home Points: In the context of poisoning, a “wide QRS” is anything greater than 100 milliseconds. A newly “wide QRS”, especially with hemodynamic instability, should prompt consideration of sodium channel blockade and not ventricular tachycardia. Treatment is guided by administration of sodium-bicarbonate. Recall that the resultant alkalemia driven by sodium-bicarbonate will shift potassium intracellularly.

Poisoning 85

Poisoning Seizures Administration EKG/ECG 85

Don't Forget the Bubbles

SEPTEMBER 27, 2023

The Choosing Wisely ® campaign is an initiative that promotes collaborative conversations between clinicians and families to safely avoid unnecessary and potentially harmful tests. The American Academy of Paediatrics Section on Emergency Medicine (AAP SOEM) created a list of five key recommendations for Paediatric Emergency Medicine after a structured review process and expert consensus opinion.

Emergency Department 84

Emergency Department Pediatrics Point-of-Care Testing Hospitals 84

Emergency Medicine Journal

SEPTEMBER 27, 2023

Clinical introduction A 76-year-old woman presented to the ED from a French restaurant complaining of a sudden onset of oral discomfort that developed 1 hour after having a hot soup. Physical examination showed a 3 x 3 cm bullous haematoma on her soft palate ( figure 1 ). She had repeated similar episodes of intraoral haematomas after meals, but other parts of the body had never been involved.

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ALiEM

SEPTEMBER 27, 2023

What well-known adverse reaction results from ingestion of the pictured mushroom? Acute hepatitis Disulfiram-like reaction with ethanol consumption Pneumonitis from inhalation of spores Seizures from glutamate agonist activity [Image from Canstockphoto] Reveal the Answer 2. Disulfiram-like reaction with ethanol consumption Coprinus atramentarius or Ink Cap mushroom is well known to cause a disulfiram-like reaction when it is consumed prior to ethanol.

Seizures 67

Seizures Academics Wellness 67

Emergency Medicine Journal

SEPTEMBER 27, 2023

Background Increasing numbers of older patients are presenting to the ED following trauma. These patients require multidisciplinary care that the traditional trauma model fails to provide. A Silver Trauma Review Clinic (STRC) was developed in conjunction with the geriatric ED and multidisciplinary services to improve the post-discharge care of patients with non-operative traumatic injuries.

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Operations Fractures Outcomes 75

EMDocs

SEPTEMBER 27, 2023

Author: Micaela LaRose, MD (Emergency Medicine Resident, San Antonio, TX) // Reviewed by: Summer Chavez, DO, MPH, MPM (Attending Physician, University of Houston); Alex Koyfman, MD (@EMHighAK); Brit Long, MD (@long_brit) Policy Playbook returns to emDOCs with a concise summary of the latest developments in emergency medicine-related health policy over the summer months.

Emergency Department 61

Emergency Department Research Outcomes Hospitals 61

Emergency Medicine Journal

SEPTEMBER 27, 2023

The Emergency Department (ED) has long been considered a ‘safety net’ for healthcare. In the USA this term is often used to indicate that patients who cannot afford to go elsewhere can always receive care in the ED. But as many of us know, the ED is a safety net in almost every healthcare system, regardless of how that care is financed, as it provides a place for patients to be seen out of hours, when general practitioners are too busy, or the patient’s problem is considered to

Emergency Department 75

Emergency Department Research 75

Maria Yang, MD

SEPTEMBER 27, 2023

It’s a short post this week, though the links will take you to nutritious brain snacks (or hors d’oeuvres , if you identify as classy): 24 Hours in an Invisible Pandemic. This is an excellent example of data visualization about the experience of loneliness in the US. 26.2 to Life. This documentary is about the San Quentin Marathon. The athletes are inmates at the San Quentin prison.

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Taming the SRU

SEPTEMBER 27, 2023

pediatric airways - Landmark studies in em - ebm in the prehospital setting - cpc - r1 diagnostics: pneumothorax - r4 capstone pediatric airways WITH dr. dean Intubation attempts should follow distinct, slow, and deliberate steps. Safety during intubation must be paid attention, which has led to safety checklists in the pediatric world. Examples of these safety measures include adequate preoxygenation, minimizing duration of attempt, limiting intubations to trained providers, and using video lar

Stroke 52

Stroke EMS Pediatrics Outcomes 52

Sensible Medicine

SEPTEMBER 27, 2023

Andrew Foy rejoins the Sensible Medicine podcast. We talk first about coronary artery calcium. Andrew is an expert in this area. We have co-written our case against CAC scoring for any cause in the American Family Physician. It’s had little effect as CAC scoring is running rampant. Sensible Medicine is a reader-supported publication. To receive new posts and support our work, consider becoming a free or paid subscriber.

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Emergency Medicine Journal

SEPTEMBER 27, 2023

Clinical negligence claims allocated to emergency medicine (EM) now account for the equal-highest volume notified to NHS Resolution (NHS-R), the body responsible for handling negligence claims on behalf of NHS organisations, sponsored by the Department of Health and Social Care. 1 NHS-R mandates the allocation of a responsible specialty within 48 hours of claim receipt, mostly allocated by medicolegal departments without clinician involvement. 1 In England, >75% of acute admissions present v

Emergency Department 52

Emergency Department EMS Outcomes 52

Sensible Medicine

SEPTEMBER 27, 2023

Andrew Foy rejoins the Sensible Medicine podcast. We talk first about coronary artery calcium. Andrew is an expert in this area. We have co-written our case against CAC scoring for any cause in the American Family Physician. It’s had little effect as CAC scoring is running rampant. Sensible Medicine is a reader-supported publication. To receive new posts and support our work, consider becoming a free or paid subscriber.

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Emergency Medicine Journal

SEPTEMBER 27, 2023

Welcome to this month’s Primary survey. This month’s journal has a variety of topics from trauma, paediatrics, ultrasound and malpractice. I’ll take you through some of the highlights. Editor’s choice: The impact of serial cardiopulmonary point of care ultrasound (PoCUS) exams in patients with acute dyspnoea: a randomised controlled trial This paper investigates if treatment guided by monitoring patients with acute dyspnoea with serial cardiopulmonary PoCUS examinations a

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Ultrasounds 52

PEMBlog

SEPTEMBER 27, 2023

This is a blog post designed to disseminate the important work of Choosing Wisely , an initiative of the the American Board of Internal Medicine Foundation, the goal of which is the spark conversations between clinicians and patients about what tests, treatments, and procedures are needed – and which ones are not. The Choosing Wisely Pediatric Emergency Medicine Recommendations The Choosing Wisely Campaign Toolkit Expert Contributors Olivia Ostrow, MD Hospital for Sick Children Toronto, Ontario,

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Pediatrics Hospitals Emergency Department Infectious Diseases 52

Emergency Medicine Journal

SEPTEMBER 27, 2023

Javidan AP, Hansen K, Higginson I et al. The International Federation for Emergency Medicine report on emergency department crowding and access block: A brief summary. Emerg Med J 2021;38:245–46. Since first publication the provenance and peer review statement has been added to this article.

Emergency Department 52

Emergency Department 52

AED Leader

SEPTEMBER 27, 2023

Knowing how to change an AED battery and also when to change it are just as important for protecting life as the initial purchase of a portable defibrillator. Battery problems are among the top causes of AED failure but are fortunately some of the easiest to prevent. Checking the battery’s expiration date and having a new battery on hand are crucial steps to the effective functioning of your AED.

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Pediatrics EMS 52

Emergency Medicine Journal

SEPTEMBER 27, 2023

Bagel slicing can be hazardous, so though I’d always emphasised safety, it wasn’t entirely surprising when my daughter cut her finger, requiring a trip to urgent care. Our 23-year-old daughter was adopted in China at 14 months, so what did surprise me was the first question from the nurse, addressed to me in the suburban waiting room: ‘does she speak English?

Urgent Care 40

Urgent Care 40

Emergency Medicine Journal

SEPTEMBER 27, 2023

We read with great interest the article by Keita Shibahashi and colleagues entitled ‘Association of the COVID-19 pandemic with bystander cardiopulmonary resuscitation for out-of-hospital cardiac arrest: a population-based analysis in Tokyo, Japan’ 1 In the past 2 years, with the onset of the COVID-19 pandemic, we expected a decrease in the bystander cardiopulmonary resuscitation (CPR) rate.

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Resuscitation Hospitals CPR Research 40

Emergency Medicine Journal

SEPTEMBER 27, 2023

Editor’s note: EMJ has partnered with the journals of multiple international emergency medicine societies to share from each a highlighted research study, as selected by their editors. This edition will feature an abstract from each publication.

Research 40

Research 40

Emergency Medicine Journal

SEPTEMBER 27, 2023

This month’s update is by the Manchester University NHS Foundation Trust team. We used a multimodal search strategy, drawing on free open-access medical education resources and literature searches. We identified the five most interesting and relevant papers (decided by consensus) and highlight the main findings, key limitations and clinical bottom line for each paper.

EKG/ECG 40

EKG/ECG Outcomes 40

Emergency Medicine Journal

SEPTEMBER 27, 2023

Clinical risk prediction models can support decision making in emergency medicine, but directing intervention towards high-risk patients may involve a flawed assumption. This concepts paper examines prognostic clinical risk prediction and specifically describes the potential impact of treatment effects in model development studies. Treatment effects may lead to models failing to achieve the aim of identifying the patients most likely to benefit from intervention, and may instead identify patient

Outcomes 40

Outcomes 40

Emergency Medicine Journal

SEPTEMBER 27, 2023

Treatment with chest drain fails commonly due to early/accidental removal. 1 2 Therefore, securing the drain is vital for success of the procedure. This study was designed to determine the most secure method of affixing a chest drain to patients’ skin using a tape (tape used was Sleek tape). Tape is a common type of fixation method for a chest drain but there is no scientific study testing the success rates of different methods.

Research 40

Research 40

Emergency Medicine Journal

SEPTEMBER 27, 2023

Clinical introduction A 78-year-old man with a recent history of general fatigue, exertional dyspnoea and recurrent epistaxis presented to our ED. His medical history was mild hyperlipidaemia. He denied chest pain, dyspnoea, leg swelling, drug abuse or facial trauma. His vital signs were stable. Physical findings also revealed pale skin and conjunctival pallor.

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Emergency Medicine Journal

SEPTEMBER 27, 2023

Background Children experience significant anxiety in the paediatric ED. Although research from preoperative and primary care samples indicates that parents experience anxiety surrounding their children’s medical procedures, less is known about parental anxiety and factors that contribute to higher parental anxiety in the ED. This study aimed to assess parental anxiety in families presenting to a paediatric ED with a variety of presenting concerns and examine demographic and psychological

Emergency Department 40

Emergency Department Psychiatric Research Outcomes 40

Emergency Medicine Journal

SEPTEMBER 27, 2023

Clinical introduction A middle-aged man is brought to your ED following a self-limiting generalised tonic–clonic seizure. He is a smoker, with a history of chronic obstructive pulmonary disease (COPD) and peripheral vascular disease, but no previous seizures. He is on aspirin and clopidogrel. On assessment, you see no evidence of trauma. He is confused, with a Glasgow Coma Scale 14 (E4, V4, M6) and mild global limb weakness but no focal neurology.

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Seizures COPD 40

Emergency Medicine Journal

SEPTEMBER 27, 2023

Background Mental health presentations in young people are increasing. Recurrence of self-harm (SH) presentations is common and of great concern since self-harm is known to be a risk factor for suicide. Previous reports suggest that the ED experience for this group is poor. A study was carried out at the Royal Berkshire NHS Foundation Trust. The objective was to pilot new and existing measures to capture the perceived needs and expectations of young people attending ED following SH compared with

Fractures 40

Fractures Research Wellness 40

Emergency Medicine Journal

SEPTEMBER 27, 2023

Case presentation A right-hand dominant woman aged 46 years with a history of opiate use disorder presents to the ED following a right clavicle injury. While riding to work, the patient fell off her bicycle, landing on her right shoulder. She denies any other injury. On physical examination, she is tearful, cradling her right arm. Her vital signs are normal.

Fractures 40

Fractures Ultrasounds 40

Emergency Medicine Journal

SEPTEMBER 27, 2023

Emergency physicians are increasingly familiar with point-of-care ultrasound (POCUS) as an adjunct to clinical examination. Although once the preserve of a small number of enthusiasts, POCUS is now a fundamental part of practising emergency medicine. Unsurprisingly, this shift has been accompanied by advances in portable ultrasound devices and the emergence of formal governance structures, such as dedicated fellowship training in POCUS, curriculum sign-offs and ED ultrasound subspecialty leads.

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Ultrasounds Emergency Department 40

Emergency Medicine Journal

SEPTEMBER 27, 2023

Jones SR, Carley S, Harrison M. An introduction to power and sample size estimation. Emerg Med J 2003;20:453–8. doi: 10.1136/emj.20.5.453. Following recent feedback from a reader, the authors have corrected this article. The original version of this paper stated that: ‘Strictly speaking, "power" refers to the number of patients required to avoid a type II error in a comparative study.’ However, the formal definition of "power" is that it is the probability of avoiding a type II

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Emergency Medicine Journal

SEPTEMBER 27, 2023

Background Serial point-of-care ultrasound (PoCUS) can potentially improve acute patient care through treatment adjusted to the dynamic ultrasound findings. The objective was to investigate if treatment guided by monitoring patients with acute dyspnoea with serial cardiopulmonary PoCUS and usual care could reduce the severity of dyspnoea compared with usual care alone.

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Ultrasounds Outcomes 52